Skip to main content Accessibility help
×
Home

Prediction of psychosis in prodrome: development and validation of a simple, personalized risk calculator

  • TianHong Zhang (a1), LiHua Xu (a1), YingYing Tang (a1), HuiJun Li (a2), XiaoChen Tang (a1), HuiRu Cui (a1), YanYan Wei (a1), Yan Wang (a1), Qiang Hu (a1), XiaoHua Liu (a1), ChunBo Li (a1), Zheng Lu (a1) (a3), Robert W. McCarley (a4), Larry J. Seidman (a4), JiJun Wang (a1) (a5) (a6) and on behalf of the SHARP (ShangHai At Risk for Psychosis) Study Group (a1) (a2) (a3) (a4) (a5) (a6)...

Abstract

Background

This study aim to derive and validate a simple and well-performing risk calculator (RC) for predicting psychosis in individual patients at clinical high risk (CHR).

Methods

From the ongoing ShangHai-At-Risk-for-Psychosis (SHARP) program, 417 CHR cases were identified based on the Structured Interview for Prodromal Symptoms (SIPS), of whom 349 had at least 1-year follow-up assessment. Of these 349 cases, 83 converted to psychosis. Logistic regression was used to build a multivariate model to predict conversion. The area under the receiver operating characteristic (ROC) curve (AUC) was used to test the effectiveness of the SIPS-RC. Second, an independent sample of 100 CHR subjects was recruited based on an identical baseline and follow-up procedures to validate the performance of the SIPS-RC.

Results

Four predictors (each based on a subset of SIPS-based items) were used to construct the SIPS-RC: (1) functional decline; (2) positive symptoms (unusual thoughts, suspiciousness); (3) negative symptoms (social anhedonia, expression of emotion, ideational richness); and (4) general symptoms (dysphoric mood). The SIPS-RC showed moderate discrimination of subsequent transition to psychosis with an AUC of 0.744 (p < 0.001). A risk estimate of 25% or higher had around 75% accuracy for predicting psychosis. The personalized risk generated by the SIPS-RC provided a solid estimate of conversion outcomes in the independent validation sample, with an AUC of 0.804 [95% confidence interval (CI) 0.662–0.951].

Conclusion

The SIPS-RC, which is simple and easy to use, can perform in the same manner as the NAPLS-2 RC in the Chinese clinical population. Such a tool may be used by clinicians to counsel appropriately their patients about clinical monitor v. potential treatment options.

Copyright

Corresponding author

Author for correspondence: JiJun Wang, E-mail: jijunwang27@163.com and Lu Zheng, E-mail: luzheng@tongji.edu.cn

Footnotes

Hide All
*

Dr Larry J. Seidman passed away on 7 September 2017. Dr Robert W. McCarley passed away on 27 May 2017. Both were founders and core members of the SHARP (ShangHai At Risk for Psychosis) project.

Footnotes

References

Hide All
Cannon, TD, Cadenhead, K, Cornblatt, B, Woods, SW, Addington, J, Walker, E, Seidman, LJ, Perkins, D, Tsuang, M, McGlashan, T and Heinssen, R (2008) Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Archives of General Psychiatry 65, 2837.
Cannon, TD, Yu, C, Addington, J, Bearden, CE, Cadenhead, KS, Cornblatt, BA, Heinssen, R, Jeffries, CD, Mathalon, DH, McGlashan, TH, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, Woods, SW and Kattan, MW (2016) An individualized risk calculator for research in prodromal psychosis. The American Journal of Psychiatry 173, 980988.
Carrion, RE, Cornblatt, BA, Burton, CZ, Tso, IF, Auther, AM, Adelsheim, S, Calkins, R, Carter, CS, Niendam, T, Sale, TG, Taylor, SF and McFarlane, WR (2016) Personalized prediction of psychosis: external validation of the NAPLS-2 psychosis risk calculator with the EDIPPP project. The American Journal of Psychiatry 173, 989996.
Cornblatt, BA, Auther, AM, Niendam, T, Smith, CW, Zinberg, J, Bearden, CE and Cannon, TD (2007) Preliminary findings for two new measures of social and role functioning in the prodromal phase of schizophrenia. Schizophrenia Bulletin 33, 688702.
Cornblatt, BA, Carrion, RE, Auther, A, McLaughlin, D, Olsen, RH, John, M and Correll, CU (2015) Psychosis prevention: a modified clinical high risk perspective from the recognition and prevention (RAP) program. The American Journal of Psychiatry 172, 986994.
DeVylder, JE, Muchomba, FM, Gill, KE, Ben-David, S, Walder, DJ, Malaspina, D and Corcoran, CM (2014) Symptom trajectories and psychosis onset in a clinical high-risk cohort: the relevance of subthreshold thought disorder. Schizophrenia Research 159, 278283.
Fusar-Poli, P, Bonoldi, I, Yung, AR, Borgwardt, S, Kempton, MJ, Valmaggia, L, Barale, F, Caverzasi, E and McGuire, P (2012) Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry 69, 220229.
Fusar-Poli, P, Borgwardt, S, Bechdolf, A, Addington, J, Riecher-Rossler, A, Schultze-Lutter, F, Keshavan, M, Wood, S, Ruhrmann, S, Seidman, LJ, Valmaggia, L, Cannon, T, Velthorst, E, De Haan, L, Cornblatt, B, Bonoldi, I, Birchwood, M, McGlashan, T, Carpenter, W, McGorry, P, Klosterkotter, J, McGuire, P and Yung, A (2013) The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 70, 107120.
Fusar-Poli, P, Nelson, B, Valmaggia, L, Yung, AR and McGuire, PK (2014) Comorbid depressive and anxiety disorders in 509 individuals with an at-risk mental state: impact on psychopathology and transition to psychosis. Schizophrenia Bulletin 40, 120131.
Kahn, RS, Sommer, IE, Murray, RM, Meyer-Lindenberg, A, Weinberger, DR, Cannon, TD, O'Donovan, M, Correll, CU, Kane, JM, van Os, J and Insel, TR (2015) Schizophrenia. Nature Reviews. Disease Primers 1, 15067.
Kline, ER, Seidman, LJ, Cornblatt, BA, Woodberry, KA, Bryant, C, Bearden, CE, Cadenhead, KS, Cannon, TD, Mathalon, DH, McGlashan, TH, Perkins, DO, Tsuang, MT, Walker, EF, Woods, SW and Addington, J (2018) Depression and clinical high-risk states: baseline presentation of depressed vs. non-depressed participants in the NAPLS-2 cohort. Schizophrenia Research 192, 357363.
Li, H, Zhang, T, Xu, L, Tang, Y, Cui, H, Wei, Y, Tang, X, Woodberry, KA, Shapiro, DI, Li, C, Seidman, LJ and Wang, J (2017) A comparison of conversion rates, clinical profiles and predictors of outcomes in two independent samples of individuals at clinical high risk for psychosis in China. Schizophrenia Research (in press).
Loewy, RL, Bearden, CE, Johnson, JK, Raine, A and Cannon, TD (2005) The prodromal questionnaire (PQ): preliminary validation of a self-report screening measure for prodromal and psychotic syndromes. Schizophrenia Research 79, 117125.
Loewy, RL, Pearson, R, Vinogradov, S, Bearden, CE and Cannon, TD (2011) Psychosis risk screening with the prodromal questionnaire-brief version (PQ-B). Schizophrenia Research 129, 4246.
McGlashan, T, Walsh, B and Woods, S (2010) The Psychosis-Risk Syndrome: Handbook for Diagnosis and Follow-up. New York: Oxford University Press.
Michel, C, Ruhrmann, S, Schimmelmann, BG, Klosterkotter, J and Schultze-Lutter, F (2014) A stratified model for psychosis prediction in clinical practice. Schizophrenia Bulletin 40, 15331542.
Miller, TJ, McGlashan, TH, Rosen, JL, Somjee, L, Markovich, PJ, Stein, K and Woods, SW (2002) Prospective diagnosis of the initial prodrome for schizophrenia based on the structured interview for prodromal syndromes: preliminary evidence of interrater reliability and predictive validity. The American Journal of Psychiatry 159, 863865.
Miller, TJ, McGlashan, TH, Rosen, JL, Cadenhead, K, Cannon, T, Ventura, J, McFarlane, W, Perkins, DO, Pearlson, GD and Woods, SW (2003) Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophrenia Bulletin 29, 703715.
Milne, BJ, Caspi, A, Crump, R, Poulton, R, Rutter, M, Sears, MR and Moffitt, TE (2009) The validity of the family history screen for assessing family history of mental disorders. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics 150B, 4149.
Perkins, DO, Jeffries, CD, Cornblatt, BA, Woods, SW, Addington, J, Bearden, CE, Cadenhead, KS, Cannon, TD, Heinssen, R, Mathalon, DH, Seidman, LJ, Tsuang, MT, Walker, EF and McGlashan, TH (2015) Severity of thought disorder predicts psychosis in persons at clinical high-risk. Schizophrenia Research 169, 169177.
Phillips, MR, Zhang, J, Shi, Q, Song, Z, Ding, Z, Pang, S, Li, X, Zhang, Y and Wang, Z (2009) Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–2005: an epidemiological survey. Lancet 373, 20412053.
Rabany, L, Weiser, M, Werbeloff, N and Levkovitz, Y (2011) Assessment of negative symptoms and depression in schizophrenia: revision of the SANS and how it relates to the PANSS and CDSS. Schizophrenia Research 126, 226230.
Roy, MA, Walsh, D and Kendler, KS (1996) Accuracies and inaccuracies of the family history method: a multivariate approach. Acta Psychiatrica Scandinavica 93, 224234.
Seidman, LJ, Giuliano, AJ, Meyer, EC, Addington, J, Cadenhead, KS, Cannon, TD, McGlashan, TH, Perkins, DO, Tsuang, MT, Walker, EF, Woods, SW, Bearden, CE, Christensen, BK, Hawkins, K, Heaton, R, Keefe, RS, Heinssen, R, Cornblatt, BA and North American Prodrome Longitudinal Study Group (2010) Neuropsychology of the prodrome to psychosis in the NAPLS consortium: relationship to family history and conversion to psychosis. Archives of General Psychiatry 67, 578588.
Seidman, LJ, Shapiro, DI, Stone, WS, Woodberry, KA, Ronzio, A, Cornblatt, BA, Addington, J, Bearden, CE, Cadenhead, KS, Cannon, TD, Mathalon, DH, McGlashan, TH, Perkins, DO, Tsuang, MT, Walker, EF and Woods, SW (2016) Association of neurocognition with transition to psychosis: baseline functioning in the second phase of the North American Prodrome Longitudinal Study. JAMA Psychiatry 73, 12391248.
Thompson, A, Nelson, B and Yung, A (2011) Predictive validity of clinical variables in the ‘at risk’ for psychosis population: international comparison with results from the North American Prodrome Longitudinal Study. Schizophrenia Research 126, 5157.
van Os, J and Guloksuz, S (2017) A critique of the ‘ultra-high risk’ and ‘transition’ paradigm. World Psychiatry 16, 200206.
Ventura, J, Hellemann, GS, Thames, AD, Koellner, V and Nuechterlein, KH (2009) Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia: a meta-analysis. Schizophrenia Research 113, 189199.
Zhang, WX, Shen, YC and Li, SR (1998) Epidemiological investigation on mental disorders in 7 areas of China. Chinese Journal of Psychiatry 31, 6971.
Zhang, T, Li, H, Woodberry, KA, Seidman, LJ, Zheng, L, Li, H, Zhao, S, Tang, Y, Guo, Q, Lu, X, Zhuo, K, Qian, Z, Chow, A, Li, C, Jiang, K, Xiao, Z and Wang, J (2014) Prodromal psychosis detection in a counseling center population in China: an epidemiological and clinical study. Schizophrenia Research 152, 391399.
Zhang, T, Cui, H, Tang, Y, Xu, L, Li, H, Wei, Y, Liu, X, Chow, A, Li, C, Jiang, K, Xiao, Z and Wang, J (2016) Correlation of social cognition and neurocognition on psychotic outcome: a naturalistic follow-up study of subjects with attenuated psychosis syndrome. Scientific Reports 6, 35017.
Zhang, TH, Li, HJ, Woodberry, KA, Xu, LH, Tang, YY, Guo, Q, Cui, HR, Liu, XH, Chow, A, Li, CB, Jiang, KD, Xiao, ZP, Seidman, LJ and Wang, JJ (2017) Two-year follow-up of a Chinese sample at clinical high risk for psychosis: timeline of symptoms, help-seeking and conversion. Epidemiology and Psychiatric Sciences 26, 287298.
Zhang, T, Cui, H, Wei, Y, Tang, Y, Xu, L, Tang, X, Zhu, Y, Jiang, L, Zhang, B, Qian, Z, Chow, A, Liu, X, Li, C, Xiao, Z and Wang, J (2018 a) Progressive decline of cognition during the conversion from prodrome to psychosis with a characteristic pattern of the theory of mind compensated by neurocognition. Schizophrenia Research 195, 554559.
Zhang, T, Xu, L, Tang, Y, Cui, H, Li, H, Wei, Y, Xu, Y, Jiang, L, Zhu, Y, Li, C, Jiang, K, Xiao, Z and Wang, J (2018 b) Using ‘WeChat’ online social networking in a real-world needs analysis of family members of youths at clinical high risk of psychosis. The Australian and New Zealand Journal of Psychiatry 52, 375382.
Zheng, L, Wang, J, Zhang, T, Li, H, Li, C and Jiang, K (2012) The Chinese version of the SIPS/SOPS: a pilot study of reliability and validity. Chinese Mental Health Journal 26, 571576.

Keywords

Type Description Title
WORD
Supplementary materials

Zhang et al. supplementary material
Zhang et al. supplementary material 1

 Word (20 KB)
20 KB

Metrics

Full text views

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

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed