P Fusar-Poli1, G Rutigliano2, D Stahl3, C Davies3, A De Micheli4, V Ramella-Cravaro3, I Bonoldi5, P McGuire3. 1. King's College London, Institute of Psychiatry, London, United Kingdom; OASIS service, South London and the Maudsley NHS Foundation Trust, London, United Kingdom. Electronic address: paolo.fusar-poli@kcl.ac.uk. 2. King's College London, Institute of Psychiatry, London, United Kingdom; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 3. King's College London, Institute of Psychiatry, London, United Kingdom. 4. King's College London, Institute of Psychiatry, London, United Kingdom; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy. 5. King's College London, Institute of Psychiatry, London, United Kingdom; OASIS service, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.
Abstract
BACKGROUND: The long-term clinical validity of the At Risk Mental State (ARMS) for the prediction of non-psychotic mental disorders is unknown. METHODS: Clinical register-based cohort study including all non-psychotic individuals assessed by the Outreach And Support in South London (OASIS) service (2002-2015). The primary outcome was risk of developing any mental disorder (psychotic or non-psychotic). Analyses included Cox proportional hazard models, Kaplan-Meier survival/failure function and C statistics. RESULTS: A total of 710 subjects were included. A total of 411 subjects were at risk (ARMS+) and 299 not at risk (ARMS-). Relative to ARMS-, the ARMS+ was associated with an increased risk (HR=4.825) of developing psychotic disorders, and a reduced risk (HR=0.545) of developing non-psychotic disorders (mainly personality disorders). At 6-year, the ARMS designation retained high sensitivity (0.873) but only modest specificity (0.456) for the prediction of psychosis onset (AUC 0.68). The brief and limited intermittent psychotic symptoms (BLIPS) subgroup had a higher risk of developing psychosis, and a lower risk of developing non-psychotic disorders as compared to the attenuated psychotic symptoms (APS) subgroup (P<0.001). CONCLUSIONS: In the long-term, the ARMS specifically predicts the onset of psychotic disorders, with modest accuracy, but not of non-psychotic disorders. Individuals meeting BLIPS criteria have distinct clinical outcomes. SIGNIFICANT OUTCOMES: In the long-term, the ARMS designation is still significantly associated with an increased risk of developing psychotic disorders but its prognostic accuracy is only modest. There is no evidence that the ARMS is associated with an increased risk of developing non-psychotic mental disorders. The BLIPS subgroup at lower risk of developing non-psychotic disorders compared to the APS subgroup. LIMITATIONS: While incident diagnoses employed in this study are high in ecological validity they have not been subjected to formal validation with research-based criteria.
BACKGROUND: The long-term clinical validity of the At Risk Mental State (ARMS) for the prediction of non-psychotic mental disorders is unknown. METHODS: Clinical register-based cohort study including all non-psychotic individuals assessed by the Outreach And Support in South London (OASIS) service (2002-2015). The primary outcome was risk of developing any mental disorder (psychotic or non-psychotic). Analyses included Cox proportional hazard models, Kaplan-Meier survival/failure function and C statistics. RESULTS: A total of 710 subjects were included. A total of 411 subjects were at risk (ARMS+) and 299 not at risk (ARMS-). Relative to ARMS-, the ARMS+ was associated with an increased risk (HR=4.825) of developing psychotic disorders, and a reduced risk (HR=0.545) of developing non-psychotic disorders (mainly personality disorders). At 6-year, the ARMS designation retained high sensitivity (0.873) but only modest specificity (0.456) for the prediction of psychosis onset (AUC 0.68). The brief and limited intermittent psychotic symptoms (BLIPS) subgroup had a higher risk of developing psychosis, and a lower risk of developing non-psychotic disorders as compared to the attenuated psychotic symptoms (APS) subgroup (P<0.001). CONCLUSIONS: In the long-term, the ARMS specifically predicts the onset of psychotic disorders, with modest accuracy, but not of non-psychotic disorders. Individuals meeting BLIPS criteria have distinct clinical outcomes. SIGNIFICANT OUTCOMES: In the long-term, the ARMS designation is still significantly associated with an increased risk of developing psychotic disorders but its prognostic accuracy is only modest. There is no evidence that the ARMS is associated with an increased risk of developing non-psychotic mental disorders. The BLIPS subgroup at lower risk of developing non-psychotic disorders compared to the APS subgroup. LIMITATIONS: While incident diagnoses employed in this study are high in ecological validity they have not been subjected to formal validation with research-based criteria.
Authors: Cathy Davies; Andrea Cipriani; John P A Ioannidis; Joaquim Radua; Daniel Stahl; Umberto Provenzani; Philip McGuire; Paolo Fusar-Poli Journal: World Psychiatry Date: 2018-06 Impact factor: 49.548
Authors: Scott W Woods; Albert R Powers; Jerome H Taylor; Charlie A Davidson; Jason K Johannesen; Jean Addington; Diana O Perkins; Carrie E Bearden; Kristin S Cadenhead; Tyrone D Cannon; Barbara A Cornblatt; Larry J Seidman; Ming T Tsuang; Elaine F Walker; Thomas H McGlashan Journal: Schizophr Bull Date: 2018-02-15 Impact factor: 9.306
Authors: Joaquim Radua; Valentina Ramella-Cravaro; John P A Ioannidis; Abraham Reichenberg; Nacharin Phiphopthatsanee; Taha Amir; Hyi Yenn Thoo; Dominic Oliver; Cathy Davies; Craig Morgan; Philip McGuire; Robin M Murray; Paolo Fusar-Poli Journal: World Psychiatry Date: 2018-02 Impact factor: 49.548
Authors: Jean Addington; Danijela Piskulic; Lu Liu; Jonathan Lockwood; Kristin S Cadenhead; Tyrone D Cannon; Barbara A Cornblatt; Thomas H McGlashan; Diana O Perkins; Larry J Seidman; Ming T Tsuang; Elaine F Walker; Carrie E Bearden; Daniel H Mathalon; Scott W Woods Journal: Schizophr Res Date: 2017-03-31 Impact factor: 4.939
Authors: Matthijs G Bossong; Mathilde Antoniades; Matilda Azis; Carly Samson; Beverley Quinn; Ilaria Bonoldi; Gemma Modinos; Jesus Perez; Oliver D Howes; James M Stone; Paul Allen; Philip McGuire Journal: JAMA Psychiatry Date: 2019-02-01 Impact factor: 21.596