Prediction of clinical outcomes beyond psychosis in the ultra‐high risk for psychosis population

Abstract

Aim: Several prediction models have been introduced to identify young people at greatest risk of transitioning to psychosis. To date, none has examined the possibility of developing a clinical prediction model of outcomes other than transition. The aims of this study were to examine the association between baseline clinical predictors and outcomes including, but not limited to, transition to psychosis in young people at risk for psychosis, and to develop a prediction model for these outcomes.Methods: Several evidence-based variables previously associated with transition to psychosis and some important clinical comorbidities experienced by ultra-high risk (UHR) individuals were identified in 202 UHR individuals. Secondary analysis of the Neurapro clinical trial were conducted to investigate the associations between these variables and favourable (remission and recovery) or unfavourable (transition to psychosis, no remission, any recurrence and relapse) clinical outcomes. Logistic regression, best subset selection, Akaike Information Criterion and receiver operating characteristic curves were used to seek the best prediction model for clinical outcomes from all combinations of possible predictors.Results: When considered individually, only higher general psychopathology levels (P = .023) was associated with the unfavourable outcomes. Prediction models suggest that general psychopathology and functioning are predictive of unfavourable outcomes. Conclusion:The predictive performance of the resulting models was modest and further research is needed. Nonetheless, when designing early intervention centres aiming to support individuals in the early phases of a mental disorder, the proper assessment of general psychopathology and functioning should be considered in order to inform interventions and length of care provided.

The Relationship between PID-5 Personality Traits and Mental States. A Study on a Group of Young Adults at Risk of Psychotic Onset

“…Although a multitude of factors have been identified that contribute to one’s susceptibility for conversion to psychosis, such as the presence of unusual content of thought, low functioning and functional decline [ 10 , 11 , 12 ], personality features [ 13 ] and personality disorders [ 14 , 15 ], how basic differences in multidimensional psychopathology can have a differential impact on course and outcomes is still unclear. Further studies are needed.…”

Personality Traits and Disorders in Adolescents at Clinical High Risk for Psychosis: Toward a Clinically Meaningful Diagnosis

“…It would seem that the presence of a PD does not affect clinical outcomes, irrespective of a transition to full-blown psychotic disorder. For example, a recent investigation by Polari et al(15) demonstrated that an additional diagnosis of borderline personality disorder was not associated with poorer outcomes, in terms of the recurrence, relapse, and remission of APS, as well as general functioning. However, further research is needed, and these results should also be replicated for outcomes other than APS.…”

Baseline data of a sequential multiple assignment randomized trial (STEP study)

“…This supports the clear need for care in the UHR group and that treatment is appropriate and fully justified (Fusar‐Poli et al, 2013). Furthermore, a high level of baseline general psychopathology seems to be an important predictor of poor outcomes broadly defined in the UHR population and therefore an important element to respond to in this population (Polari et al, 2020). Regarding cognitive problems and biases, the scores of the present UHR sample were comparable to those with later‐stage schizophrenia spectrum disorders.…”