IMPORTANCE: The ultra high-risk (UHR) criteria were introduced to prospectively identify patients at high risk of psychotic disorder. Although the short-term outcome of UHR patients has been well researched, the long-term outcome is not known. OBJECTIVE: To assess the rate and baseline predictors of transition to psychotic disorder in UHR patients up to 15 years after study entry. DESIGN: Follow-up study of a cohort of UHR patients recruited to participate in research studies between 1993 and 2006. SETTING: The Personal Assessment and Crisis Evaluation (PACE) clinic, a specialized service for UHR patients in Melbourne, Australia. PARTICIPANTS: Four hundred sixteen UHR patients previously seen at the PACE clinic. MAIN OUTCOMES AND MEASURES: Transition to psychotic disorder, as measured using the Comprehensive Assessment of At-Risk Mental States, Brief Psychiatric Rating Scale/Comprehensive Assessment of Symptoms and History, or state public mental health records. RESULTS: During the time to follow-up (2.4-14.9 years after presentation), 114 of the 416 participants were known to have developed a psychotic disorder. The highest risk for transition was within the first 2 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% over a 10-year period (95% CI, 28.7%-40.6%). Factors associated with transition included year of entry into the clinic, duration of symptoms before clinic entry, baseline functioning, negative symptoms, and disorders of thought content. CONCLUSIONS AND RELEVANCE: The UHR patients are at long-term risk for psychotic disorder, with the highest risk in the first 2 years. Services should aim to follow up patients for at least this period, with the possibility to return for care after this time. Individuals with a long duration of symptoms and poor functioning at the time of referral may need closer monitoring. Interventions to improve functioning and detect help-seeking UHR patients earlier also may be indicated.
IMPORTANCE: The ultra high-risk (UHR) criteria were introduced to prospectively identify patients at high risk of psychotic disorder. Although the short-term outcome of UHR patients has been well researched, the long-term outcome is not known. OBJECTIVE: To assess the rate and baseline predictors of transition to psychotic disorder in UHR patients up to 15 years after study entry. DESIGN: Follow-up study of a cohort of UHR patients recruited to participate in research studies between 1993 and 2006. SETTING: The Personal Assessment and Crisis Evaluation (PACE) clinic, a specialized service for UHR patients in Melbourne, Australia. PARTICIPANTS: Four hundred sixteen UHR patients previously seen at the PACE clinic. MAIN OUTCOMES AND MEASURES: Transition to psychotic disorder, as measured using the Comprehensive Assessment of At-Risk Mental States, Brief Psychiatric Rating Scale/Comprehensive Assessment of Symptoms and History, or state public mental health records. RESULTS: During the time to follow-up (2.4-14.9 years after presentation), 114 of the 416 participants were known to have developed a psychotic disorder. The highest risk for transition was within the first 2 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% over a 10-year period (95% CI, 28.7%-40.6%). Factors associated with transition included year of entry into the clinic, duration of symptoms before clinic entry, baseline functioning, negative symptoms, and disorders of thought content. CONCLUSIONS AND RELEVANCE: The UHR patients are at long-term risk for psychotic disorder, with the highest risk in the first 2 years. Services should aim to follow up patients for at least this period, with the possibility to return for care after this time. Individuals with a long duration of symptoms and poor functioning at the time of referral may need closer monitoring. Interventions to improve functioning and detect help-seeking UHR patients earlier also may be indicated.
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Authors: Jadon R Webb; Jean Addington; Diana O Perkins; Carrie E Bearden; Kristin S Cadenhead; Tyrone D Cannon; Barbara A Cornblatt; Robert K Heinssen; Larry J Seidman; Sarah I Tarbox; Ming T Tsuang; Elaine F Walker; Thomas H McGlashan; Scott W Woods Journal: Schizophr Bull Date: 2015-09 Impact factor: 9.306
Authors: Minji Bang; Jee In Kang; Se Joo Kim; Jin Young Park; Kyung Ran Kim; Su Young Lee; Kyungmee Park; Eun Lee; Seung-Koo Lee; Suk Kyoon An Journal: Schizophr Bull Date: 2019-10-24 Impact factor: 9.306
Authors: Barnaby Nelson; G Paul Amminger; Hok Pan Yuen; Nicky Wallis; Melissa J Kerr; Lisa Dixon; Cameron Carter; Rachel Loewy; Tara A Niendam; Martha Shumway; Sarah Morris; Julie Blasioli; Patrick D McGorry Journal: Early Interv Psychiatry Date: 2017-07-18 Impact factor: 2.732
Authors: Anthony W Zoghbi; Joel A Bernanke; Julia Gleichman; Michael D Masucci; Cheryl M Corcoran; Allegra Califano; Justin Segovia; Tiziano Colibazzi; Michael B First; Gary Brucato; Ragy R Girgis Journal: J Psychiatr Res Date: 2019-04-21 Impact factor: 4.791
Authors: Jean Addington; Lu Liu; Lisa Buchy; Kristin S Cadenhead; Tyrone D Cannon; Barbara A Cornblatt; Diana O Perkins; Larry J Seidman; Ming T Tsuang; Elaine F Walker; Scott W Woods; Carrie E Bearden; Daniel H Mathalon; Thomas H McGlashan Journal: J Nerv Ment Dis Date: 2015-05 Impact factor: 2.254
Authors: Andrew D Thompson; Barnaby Nelson; Hok Pan Yuen; Ashleigh Lin; Günter Paul Amminger; Patrick D McGorry; Stephen J Wood; Alison R Yung Journal: Schizophr Bull Date: 2013-03-02 Impact factor: 9.306
Authors: S M Cotton; K M Filia; A Ratheesh; K Pennell; S Goldstone; P D McGorry Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2016-01 Impact factor: 4.328