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Predicting psychosis in high-risk patients

Researchers have found that the risk of developing psychosis amongst people classed as ‘high risk’ increases steadily from 18% six months after the first presentation to services, to 36% after three years. The research, led by Dr Paolo Fusar-Poli at the Institute of Psychiatry at King’s College London, was published today in Archives of General Psychiatry and offers an important step towards accurately predicting psychosis and identifying those that will benefit from early interventions programmes. 

The researchers reviewed data from 27 studies from around to world, enabling them to analyze the transition risk of over 2,500 people classed as being at clinical high risk of developing psychosis. 

Individuals classed as ‘clinically high risk’ have generally already experienced subtle, sub-threshold symptoms of psychosis without having reached the severity of a full blown psychotic episode. However, current data on the risk of transition from the clinical high risk state to full illness varies between centres, with some studies suggesting that the overall risk of transition to full illness may be declining. 

This new meta-analysis shows that there is a consistent transition risk to full illness, of 18% six months after the first presentation to services, 22% after one year, 29% after two years and 36% after three years.  The findings suggest that the differences in transition risks amongst subjects were mainly associated with age, the nature of the treatment provided, and the way the syndrome and transition to psychosis were diagnosed.  

Dr Fusar-Poli adds: “The biggest challenge facing us today in psychiatry is how to accurately predict and prevent psychiatric disorders from developing. The first step towards making this a clinical reality is to be able to identify individuals at high risk, and define what their risk of developing the full illness is over a specific timeframe. Our research shows there is a very high risk that these individuals will develop psychosis within the first three years, and that the risk progressively increases over this period. I hope that our research will further help inform early intervention programmes for psychosis.”

The authors acknowledge the supprt of the EU-GEI study (project of the European network of national schizophrenia networks studying Gene-Environment Interactions). The research leading to these results has received funding from the European Community’s Seventh Framework Programme. 

For full paper: Fusar-Poli, P. et al. ‘Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk’, Archives of General Psychiatry (March 2012) 

Dr Fusar-Poli also commented on the significance of his findings in terms of the new DSM-5 mental illness diagnosis. Paolo Fusar-Poli and Alison R Yung ‘Should attenuated psychosis syndrome be included in DSM-5?’ The Lancet (18 February 2012) doi:10.1016/S0140-6736(11)61507-9

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