Skip to main content
×
×
Home

Predicting early transition from sub-syndromal presentations to major mental disorders

  • Shane P.M. Cross (a1), Jan Scott (a2) and Ian B. Hickie (a1)
Abstract
Background

Transition from at-risk state to full syndromal mental disorders is underexplored for unipolar and bipolar disorders compared with psychosis.

Aims

Prospective, trans-diagnostic study of rates and predictors of early transition from sub-threshold to full syndromal mental disorder.

Method

One-year outcome of 243 consenting youth aged 15–25 years with a sub-syndromal presentation of a potentially severe mental disorder. Survival analysis and odds ratio (OR) for predictors of transition identified from baseline clinical and demographic ratings.

Results

About 17% (n=36) experienced transition to a major mental disorder. Independent of syndromal diagnosis, transition was significantly more likely in individuals who were NEET (not in education, employment or training), in females and in those with more negative psychological symptoms (e.g. social withdrawal).

Conclusions

NEET status and negative symptoms are modifiable predictors of illness trajectory across diagnostic categories and are not specific to transition to psychosis.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Predicting early transition from sub-syndromal presentations to major mental disorders
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Predicting early transition from sub-syndromal presentations to major mental disorders
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Predicting early transition from sub-syndromal presentations to major mental disorders
      Available formats
      ×
Copyright
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
Corresponding author
Shane P.M. Cross, Brain and Mind Centre, University of Sydney, 100 Mallet Street, Camperdown, NSW 2050, Australia. E-mail: shane.cross@sydney.edu.au
Footnotes
Hide All

Declaration of interest

I.B.H. has been a Commissioner in Australia's National Mental Health Commission since 2012. He was a board member of headspace: National Youth Mental Health Foundation until January 2012. He has led a range of community-based and pharmaceutical industry-supported depression awareness and education and training programmes. He has led projects for health professionals and the community supported by governmental, community agency and pharmaceutical industry partners (Wyeth, Eli Lilly, Servier, Pfizer, AstraZeneca) for the identification and management of depression and anxiety. He has received honoraria for presentations of his own work at educational seminars supported by a number of non-government organisations and the pharmaceutical industry (including Servier, Pfizer, AstraZeneca and Eli Lilly). He is a member of the Medical Advisory Panel for Medibank Private and also a board member of Psychosis Australia Trust. He leads an investigator-initiated study of the effects of agomelatine on circadian parameters (supported in part by Servier) and has participated in a multicentre clinical trial of the effects of agomelatine on sleep architecture in depression and a Servier-supported study of major depression and sleep disturbance in primary care settings.

Footnotes
References
Hide All
1 Gore, FM, Bloem, PJN, Patton, GC, Ferguson, J, Joseph, V, Coffey, C, et al. Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet 2011; 377: 2093–102.
2 Kessler, RC, Amminger, GP, Aguilar-Gaxiola, S, Alonso, J, Lee, S, Ustun, TB. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry 2007; 20: 359–64.
3 Hickie, I, Scott, J, McGorry, P. Clinical staging for mental disorders: a new development in diagnostic practice in mental health. Med J Aust 2013; 198: 461–2.
4 Scott, J, Leboyer, M, Hickie, I, Berk, M, Kapczinski, F, Frank, E, et al. Clinical staging in psychiatry: a cross-cutting model of diagnosis with heuristic and practical value. Br J Psychiatry 2013; 202: 243–5.
5 Hartmann, JA, Yuen, HP, McGorry, PD, Yung, AR, Lin, A, Wood, SJ, et al. Declining transition rates to psychotic disorder in “ultra-high risk” clients: investigation of a dilution effect. Schizophr Res 2016; 170: 130–6.
6 Simon, AE, Velthorst, E, Nieman, DH, Linszen, D, Umbricht, D, de Haan, L. Ultra high-risk state for psychosis and non-transition: a systematic review. Schizophr Res 2011; 132: 817.
7 Simon, AE, Borgwardt, S, Riecher-Rössler, A, Velthorst, E, de Haan, L, Fusar-Poli, P. Moving beyond transition outcomes: meta-analysis of remission rates in individuals at high clinical risk for psychosis. Psychiatry Res 2013; 209: 266–72.
8 Cross, SP, Hermens, DF, Scott, EM, Ottavio, A, McGorry, PD, Hickie, IB. A clinical staging model for early intervention youth mental health services. Psychiatr Serv 2014; 65: 939–43.
9 Cross, SP, Hermens, DF, Hickie, IB. Treatment patterns and short-term outcomes in an early intervention youth mental health service. Early Interv Psychiatry 2014.
10 Cross, SPM, Hermens, DF, Scott, J, Salvador-Carulla, L, Hickie, IB. Differential impact of current diagnosis and clinical stage on attendance at a youth mental health service. Early Interv Psychiatry 2017; 11: 255–62.
11 Fusar-Poli, P, Yung, AR, McGorry, P, van Os, J. Lessons learned from the psychosis high-risk state: towards a general staging model of prodromal intervention. Psychol Med 2014; 44: 1724.
12 Valmaggia, L, Stahl, D, Yung, A, Nelson, B, Fusar-Poli, P, McGorry, P, et al. Negative psychotic symptoms and impaired role functioning predict transition outcomes in the at-risk mental state: a latent class cluster analysis study. Psychol Medicine 2013; 43: 2311–25.
13 Yung, AR, Phillips, LJ, Yuen, HP, Francey, SM, McFarlane, CA, Hallgren, M, et al. Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group. Schizophr Res 2003; 60: 2132.
14 Dragt, S, Nieman, DH, Veltman, D, Becker, HE, van de Fliert, R, de Haan, L, et al. Environmental factors and social adjustment as predictors of a first psychosis in subjects at ultra high risk. Schizophr Res 2011; 125: 6976.
15 Fusar-Poli, P, Byrne, M, Valmaggia, L, Day, F, Tabraham, P, Johns, L, et al. Social dysfunction predicts two years clinical outcome in people at ultra high risk for psychosis. J Psychiatr Res 2010; 44: 294301.
16 Ising, H, Ruhrmann, S, Burger, N, Rietdijk, J, Dragt, S, Klaassen, R, et al. Development of a stage-dependent prognostic model to predict psychosis in ultra-high-risk patients seeking treatment for co-morbid psychiatric disorders. Psychol Med 2016; 46: 1839–51.
17 Scott, J, Fowler, D, McGorry, P, Birchwood, M, Killackey, E, Christensen, H, et al. Adolescents and young adults who are not in employment, education, or training. BMJ 2013; 347: f5270.
18 Hickie, IB, Scott, EM, Hermens, DF, Naismith, SL, Guastella, AJ, Kaur, M, et al. Applying clinical staging to young people who present for mental health care. Early Interv Psychiatry 2013; 7: 3143.
19 McGorry, P, Tanti, C, Stokes, R, Hickie, I, Carnell, K, Littlefield, L, et al. headspace: Australia's National Youth Mental Health Foundation – where young minds come first. Med J Aust 2007; 187: S6870.
20 Kessler, RC, Andrews, G, Colpe, LJ, Hiripi, E, Mroczek, DK, Normand, SLT, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002; 32: 959–76.
21 Shafer, A. Meta-analysis of the brief psychiatric rating scale factor structure. Psychol Assess 2005; 17: 324–35.
22 Goldman, H, Skodol, A, Lave, T. Revising axis V for DSM-IV: a review of measures of social functioning. Am J Psychiatry 1992; 149: 1148–56.
23 O’Dea, B, Glozier, N, Purcell, R, McGorry, PD, Scott, J, Feilds, K-L, et al. A cross-sectional exploration of the clinical characteristics of disengaged (NEET) young people in primary mental healthcare. BMJ Open. 2014; 4: e006378.
24 O’Connor, K, Nelson, B, Lin, A, Wood, SJ, Yung, A, Thompson, A. Are UHR patients who present with hallucinations alone at lower risk of transition to psychosis? Psychiatry Res 2015; 235: 177–96.
25 Baggio, S, Iglesias, K, Deline, S, Studer, J, Henchoz, Y, Mohler-Kuo, M, et al. Not in education, employment, or training status among young Swiss men. Longitudinal associations with mental health and substance use. J Adolesc Health 2015; 56: 238–43.
26 Brandizzi, M, Valmaggia, L, Byrne, M, Jones, C, Iwegbu, N, Badger, S, et al. Predictors of functional outcome in individuals at high clinical risk for psychosis at six years follow-up. J Psychiatr Res 2015; 65: 115–23.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Open
  • ISSN: -
  • EISSN: 2056-4724
  • URL: /core/journals/bjpsych-open
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 57 *
Loading metrics...

Abstract views

Total abstract views: 91 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 21st June 2018. This data will be updated every 24 hours.

Predicting early transition from sub-syndromal presentations to major mental disorders

  • Shane P.M. Cross (a1), Jan Scott (a2) and Ian B. Hickie (a1)
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *