P Fusar-Poli1, E Palombini2, C Davies2, D Oliver2, I Bonoldi3, V Ramella-Cravaro2, P McGuire4. 1. Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, 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. Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom. 3. Early Psychosis: Interventions & Clinical-detection (EPIC) lab, Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; OASIS Service, South London and the Maudsley NHS Foundation Trust, London, United Kingdom. 4. Department of Psychosis Studies, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom.
Abstract
BACKGROUND: The reason for declining risk to psychosis across individuals assessed and meeting Ultra High Risk (UHR) criteria is still unclear. No studies have investigated the potential substantial role of the underlying risk enrichment across all the individuals undergoing an UHR assessment. METHODS: Cohort study including all non-psychotic subjects who were assessed on suspicion of psychosis risk by the OASIS UHR service in the period 2001 to 2015. Posttest (after UHR assessment) and pretest risk (before UHR assessment) of psychosis were stratified and compared across three time periods (2001-2005, 2006-2010, 2011-2015) with Cox analysis and modulating factors were investigated. RESULTS: The posttest risk of psychosis at the OASIS service has increased from the initial pilot years of the service (2001-2005) and then stabilised and not declined over the following decade (2006-2010 and 2011-2015). This was paralleled by a similar course of pretest risk for psychosis. Stability of pretest risk for psychosis over the past decade was associated with a lack of change in ethnicity and to counterweighting changes in the type of referral sources over different time periods. CONCLUSIONS: The time course of transition risk to psychosis in UHR services is strictly associated with the time course of pretest risk enrichment. If the latter remains stable over time, as for the OASIS service, no declining transition risk is observed over the most recent years. Pretest risk enrichment is determined by recruitment and sampling strategies. This study confirms the need to control these factors in the UHR field.
BACKGROUND: The reason for declining risk to psychosis across individuals assessed and meeting Ultra High Risk (UHR) criteria is still unclear. No studies have investigated the potential substantial role of the underlying risk enrichment across all the individuals undergoing an UHR assessment. METHODS: Cohort study including all non-psychotic subjects who were assessed on suspicion of psychosis risk by the OASIS UHR service in the period 2001 to 2015. Posttest (after UHR assessment) and pretest risk (before UHR assessment) of psychosis were stratified and compared across three time periods (2001-2005, 2006-2010, 2011-2015) with Cox analysis and modulating factors were investigated. RESULTS: The posttest risk of psychosis at the OASIS service has increased from the initial pilot years of the service (2001-2005) and then stabilised and not declined over the following decade (2006-2010 and 2011-2015). This was paralleled by a similar course of pretest risk for psychosis. Stability of pretest risk for psychosis over the past decade was associated with a lack of change in ethnicity and to counterweighting changes in the type of referral sources over different time periods. CONCLUSIONS: The time course of transition risk to psychosis in UHR services is strictly associated with the time course of pretest risk enrichment. If the latter remains stable over time, as for the OASIS service, no declining transition risk is observed over the most recent years. Pretest risk enrichment is determined by recruitment and sampling strategies. This study confirms the need to control these factors in the UHR field.
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: Paolo Fusar-Poli; Andrea De Micheli; Rashmi Patel; Lorenzo Signorini; Syed Miah; Thomas Spencer; Philip McGuire Journal: Schizophr Bull Date: 2020-04-18 Impact factor: 9.306
Authors: Paolo Fusar-Poli; Christoph U Correll; Celso Arango; Michael Berk; Vikram Patel; John P A Ioannidis Journal: World Psychiatry Date: 2021-06 Impact factor: 79.683
Authors: Cathy Davies; Joaquim Radua; Andrea Cipriani; Daniel Stahl; Umberto Provenzani; Philip McGuire; Paolo Fusar-Poli Journal: Front Psychiatry Date: 2018-06-12 Impact factor: 4.157
Authors: B Nelson; G P Amminger; H P Yuen; C Markulev; S Lavoie; M R Schäfer; J A Hartmann; N Mossaheb; M Schlögelhofer; S Smesny; I B Hickie; G Berger; E Y H Chen; L de Haan; D H Nieman; M Nordentoft; A Riecher-Rössler; S Verma; A Thompson; A R Yung; P D McGorry Journal: NPJ Schizophr Date: 2018-06-25
Authors: Paolo Fusar-Poli; Dominic Oliver; Giulia Spada; Rashmi Patel; Robert Stewart; Richard Dobson; Philip McGuire Journal: Front Psychiatry Date: 2019-03-13 Impact factor: 4.157
Authors: Marco Solmi; Joaquim Radua; Brendon Stubbs; Valdo Ricca; Davide Moretti; Daniele Busatta; Andre F Carvalho; Elena Dragioti; Angela Favaro; Alessio Maria Monteleone; Jae Il Shin; Paolo Fusar-Poli; Giovanni Castellini Journal: Braz J Psychiatry Date: 2020-09-28 Impact factor: 2.697
Authors: Paolo Fusar-Poli; Dominic Stringer; Alice M S Durieux; Grazia Rutigliano; Ilaria Bonoldi; Andrea De Micheli; Daniel Stahl Journal: Transl Psychiatry Date: 2019-10-17 Impact factor: 6.222