Frauke Schultze-Lutter1, Joachim Klosterkötter2, Stephan Ruhrmann3. 1. University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr. 111, 3000 Bern 60, Switzerland. Electronic address: frauke.schultze-lutter@kjp.unibe.ch. 2. University of Cologne, Department of Psychiatry and Psychotherapy, Kerpener Str. 62, 50937 Cologne, Germany. Electronic address: joachim.klosterkoetter@uk-koeln.de. 3. University of Cologne, Department of Psychiatry and Psychotherapy, Kerpener Str. 62, 50937 Cologne, Germany. Electronic address: stephan.ruhrmann@uk-koeln.de.
Abstract
OBJECTIVE: Cognitive impairments are regarded as a core component of schizophrenia. However, the cognitive dimension of psychosis is hardly considered by ultra-high risk (UHR) criteria. Therefore, we studied whether the combination of symptomatic UHR criteria and the basic symptom criterion "cognitive disturbances" (COGDIS) is superior in predicting first-episode psychosis. METHOD: In a naturalistic 48-month follow-up study, the conversion rate to first-episode psychosis was studied in 246 outpatients of an early detection of psychosis service (FETZ); thereby, the association between conversion, and the combined and singular use of UHR criteria and COGDIS was compared. RESULTS: Patients that met UHR criteria and COGDIS (n=127) at baseline had a significantly higher risk of conversion (hr=0.66 at month 48) and a shorter time to conversion than patients that met only UHR criteria (n=37; hr=0.28) or only COGDIS (n=30; hr=0.23). Furthermore, the risk of conversion was higher for the combined criteria than for UHR criteria (n=164; hr=0.56 at month 48) and COGDIS (n=158; hr=0.56 at month 48) when considered irrespective of each other. CONCLUSIONS: Our findings support the merits of considering both COGDIS and UHR criteria in the early detection of persons who are at high risk of developing a first psychotic episode within 48months. Applying both sets of criteria improves sensitivity and individual risk estimation, and may thereby support the development of stage-targeted interventions. Moreover, since the combined approach enables the identification of considerably more homogeneous at-risk samples, it should support both preventive and basic research.
OBJECTIVE:Cognitive impairments are regarded as a core component of schizophrenia. However, the cognitive dimension of psychosis is hardly considered by ultra-high risk (UHR) criteria. Therefore, we studied whether the combination of symptomatic UHR criteria and the basic symptom criterion "cognitive disturbances" (COGDIS) is superior in predicting first-episode psychosis. METHOD: In a naturalistic 48-month follow-up study, the conversion rate to first-episode psychosis was studied in 246 outpatients of an early detection of psychosis service (FETZ); thereby, the association between conversion, and the combined and singular use of UHR criteria and COGDIS was compared. RESULTS:Patients that met UHR criteria and COGDIS (n=127) at baseline had a significantly higher risk of conversion (hr=0.66 at month 48) and a shorter time to conversion than patients that met only UHR criteria (n=37; hr=0.28) or only COGDIS (n=30; hr=0.23). Furthermore, the risk of conversion was higher for the combined criteria than for UHR criteria (n=164; hr=0.56 at month 48) and COGDIS (n=158; hr=0.56 at month 48) when considered irrespective of each other. CONCLUSIONS: Our findings support the merits of considering both COGDIS and UHR criteria in the early detection of persons who are at high risk of developing a first psychotic episode within 48months. Applying both sets of criteria improves sensitivity and individual risk estimation, and may thereby support the development of stage-targeted interventions. Moreover, since the combined approach enables the identification of considerably more homogeneous at-risk samples, it should support both preventive and basic research.
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Authors: Mark J Millan; Annie Andrieux; George Bartzokis; Kristin Cadenhead; Paola Dazzan; Paolo Fusar-Poli; Jürgen Gallinat; Jay Giedd; Dennis R Grayson; Markus Heinrichs; René Kahn; Marie-Odile Krebs; Marion Leboyer; David Lewis; Oscar Marin; Philippe Marin; Andreas Meyer-Lindenberg; Patrick McGorry; Philip McGuire; Michael J Owen; Paul Patterson; Akira Sawa; Michael Spedding; Peter Uhlhaas; Flora Vaccarino; Claes Wahlestedt; Daniel Weinberger Journal: Nat Rev Drug Discov Date: 2016-03-04 Impact factor: 84.694