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Recency and intensification of positive symptoms enhance prediction of conversion to syndromal psychosis in clinical high-risk patients

Published online by Cambridge University Press:  29 October 2019

Gary Brucato ,
Michael B. First ,
Gabriella A. Dishy ,
Shana S. Samuel ,
Qing Xu ,
Melanie M. Wall ,
Scott A. Small ,
Michael D. Masucci ,
Jeffrey A. Lieberman  and
Ragy R. Girgis Open the ORCID record for Ragy R. Girgis [Opens in a new window]
Gary Brucato
Affiliation:
Department of Psychiatry, The Center of Prevention & Evaluation (COPE), Columbia University College of Physicians & Surgeons, Columbia University Medical Center, New York State Psychiatric Institute, NY, USA
Michael B. First
Affiliation:
Columbia University College of Physicians & Surgeons, Columbia University Medical Center, New York State Psychiatric Institute, NY, USA
Gabriella A. Dishy
Affiliation:
New York State Psychiatric Institute, NY, USA
Shana S. Samuel
Affiliation:
New York State Psychiatric Institute, NY, USA
Qing Xu
Affiliation:
New York State Psychiatric Institute, NY, USA
Melanie M. Wall
Affiliation:
Columbia University College of Physicians & Surgeons, Columbia University Medical Center, New York State Psychiatric Institute, NY, USA
Scott A. Small
Affiliation:
Alzheimer's Disease Research Center, Departments of Neurology, Psychiatry, Radiology, Columbia University, NY, USA
Michael D. Masucci
Affiliation:
New York State Psychiatric Institute, NY, USA
Jeffrey A. Lieberman
Affiliation:
Columbia University, Vagelos College of Physicians and Surgeons, Director, New York State Psychiatric Institute Psychiatrist-in-Chief, New York Presbyterian Hospital-Columbia University Medical Center, NY, USA
Ragy R. Girgis*
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York> State Psychiatric Institute, NY, USA
*
Author for correspondence: Ragy R. Girgis, E-mail: ragy.girgis@nyspi.columbia.edu
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Abstract

Background

Early detection and intervention strategies in patients at clinical high-risk (CHR) for syndromal psychosis have the potential to contain the morbidity of schizophrenia and similar conditions. However, research criteria that have relied on severity and number of positive symptoms are limited in their specificity and risk high false-positive rates. Our objective was to examine the degree to which measures of recency of onset or intensification of positive symptoms [a.k.a., new or worsening (NOW) symptoms] contribute to predictive capacity.

Methods

We recruited 109 help-seeking individuals whose symptoms met criteria for the Progression Subtype of the Attenuated Positive Symptom Psychosis-Risk Syndrome defined by the Structured Interview for Psychosis-Risk Syndromes and followed every three months for two years or onset of syndromal psychosis.

Results

Forty-one (40.6%) of 101 participants meeting CHR criteria developed a syndromal psychotic disorder [mostly (80.5%) schizophrenia] with half converting within 142 days (interquartile range: 69–410 days). Patients with more NOW symptoms were more likely to convert (converters: 3.63 ± 0.89; non-converters: 2.90 ± 1.27; p = 0.001). Patients with stable attenuated positive symptoms were less likely to convert than those with NOW symptoms. New, but not worsening, symptoms, in isolation, also predicted conversion.

Conclusions

Results suggest that the severity and number of attenuated positive symptoms are less predictive of conversion to syndromal psychosis than the timing of their emergence and intensification. These findings also suggest that the earliest phase of psychotic illness involves a rapid, dynamic process, beginning before the syndromal first episode, with potentially substantial implications for CHR research and understanding the neurobiology of psychosis.

Keywords

Clinical high riskconversionnewpsychosisschizophreniastructured interview for psychosis risk syndromesworsening
Type
Original Articles
Information
Psychological Medicine , Volume 51 , Issue 1 , January 2021 , pp. 112 - 120
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Copyright
Copyright © Cambridge University Press 2019

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