Long-Term Follow-Up Appears to Confirm Validity of Ultra-High-Risk Criteria for Psychosis

Patients deemed to be at “ultra high risk” (UHR) for psychosis are at substantial risk for developing a psychotic disorder over the long term, with the highest risk in the first two years, according to a report online in JAMA-Psychiatry. Barnaby Nelson, Ph.D., of the Orygen Youth Health Research Centre in Melbourne, Australia, and colleagues assessed the rate and baseline predictors of transition to psychotic disorder in 416 UHR patients seen between 1993 and 2006 at a clinic with a specialized service for UHR patients. They were followed for two to 15 years after presentation.

Transition to psychosis was measured with the Comprehensive Assessment of At-Risk Mental States, Brief Psychiatric Rating Scale/Comprehensive Assessment of Symptoms and History, or state public mental health records. During the time to follow-up, 114 of the 416 participants were known to have developed a psychotic disorder. The highest risk for transition was within the first two years of entry into the service, but individuals continued to be at risk up to 10 years after initial referral. The overall rate of transition was estimated to be 34.9 percent over a 10-year period.

“Long duration of symptoms, low functioning, negative symptoms, and disorders of thought content predicted psychosis," the researchers said. "Ongoing research is needed to identify additional robust predictors. Services should aim to follow up patients for at least two years. Individuals with a long duration of symptoms and poor functioning may need closer monitoring.”

The study is posted here. For more information on psychosis risk, see Psychiatric News here.

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