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Checking the predictive accuracy of basic symptoms against ultra high-risk criteria and testing of a multivariable prediction model: Evidence from a prospective three-year observational study of persons at clinical high-risk for psychosis

Published online by Cambridge University Press:  23 March 2020

M.P. Hengartner ,
K. Heekeren ,
D. Dvorsky ,
S. Walitza ,
W. Rössler  and
A. Theodoridou
M.P. Hengartner*
Affiliation:
Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
K. Heekeren
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
D. Dvorsky
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
S. Walitza
Affiliation:
Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zurich, Switzerland
W. Rössler
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Berlin, Germany Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil
A. Theodoridou
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
*
*Corresponding author. Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), PO Box 707, 8037 Zurich, Switzerland. E-mail address:michaelpascal.hengartner@zhaw.ch (M.P. Hengartner).
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Abstract

Background:

The aim of this study was to critically examine the prognostic validity of various clinical high-risk (CHR) criteria alone and in combination with additional clinical characteristics.

Methods:

A total of 188 CHR positive persons from the region of Zurich, Switzerland (mean age 20.5 years; 60.2% male), meeting ultra high-risk (UHR) and/or basic symptoms (BS) criteria, were followed over three years. The test battery included the Structured Interview for Prodromal Syndromes (SIPS), verbal IQ and many other screening tools. Conversion to psychosis was defined according to ICD-10 criteria for schizophrenia (F20) or brief psychotic disorder (F23).

Results:

Altogether n = 24 persons developed manifest psychosis within three years and according to Kaplan–Meier survival analysis, the projected conversion rate was 17.5%. The predictive accuracy of UHR was statistically significant but poor (area under the curve [AUC] = 0.65, P < .05), whereas BS did not predict psychosis beyond mere chance (AUC = 0.52, P = .730). Sensitivity and specificity were 0.83 and 0.47 for UHR, and 0.96 and 0.09 for BS. UHR plus BS achieved an AUC = 0.66, with sensitivity and specificity of 0.75 and 0.56. In comparison, baseline antipsychotic medication yielded a predictive accuracy of AUC = 0.62 (sensitivity = 0.42; specificity = 0.82). A multivariable prediction model comprising continuous measures of positive symptoms and verbal IQ achieved a substantially improved prognostic accuracy (AUC = 0.85; sensitivity = 0.86; specificity = 0.85; positive predictive value = 0.54; negative predictive value = 0.97).

Conclusions:

We showed that BS have no predictive accuracy beyond chance, while UHR criteria poorly predict conversion to psychosis. Combining BS with UHR criteria did not improve the predictive accuracy of UHR alone. In contrast, dimensional measures of both positive symptoms and verbal IQ showed excellent prognostic validity. A critical re-thinking of binary at-risk criteria is necessary in order to improve the prognosis of psychotic disorders.

Keywords

Clinical high riskPrognostic validityPsychosisSchizophreniaTransitionConversion
Type
Original article
Information
European Psychiatry , Volume 45 , September 2017 , pp. 27 - 35
Copyright
Copyright © European Psychiatric Association 2017

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