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Poor functional recovery is better predicted than conversion in studies of outcomes of clinical high risk of psychosis: insight from SHARP

Published online by Cambridge University Press:  27 August 2019

TianHong Zhang ,
ShuWen Yang ,
LiHua Xu ,
XiaoChen Tang ,
YanYan Wei ,
HuiRu Cui ,
HuiJun Li ,
YingYing Tang ,
Li Hui  and
ChunBo Li
...Show all authors
TianHong Zhang
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
ShuWen Yang
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
LiHua Xu
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
XiaoChen Tang
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
YanYan Wei
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
HuiRu Cui
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
HuiJun Li
Affiliation:
Department of Psychology, Florida A&M University, Tallahassee, Florida32307, USA
YingYing Tang
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
Li Hui
Affiliation:
Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Soochow University, Suzhou215137, Jiangsu, PR China
ChunBo Li
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
XingShi Chen*
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Soochow University, Suzhou215137, Jiangsu, PR China
JiJun Wang*
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai, PR China Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
*
Author for correspondence: JiJun Wang, E-mail: jijunwang27@163.com; XingShi Chen, E-mail: chenxingshi2008@163.com
Author for correspondence: JiJun Wang, E-mail: jijunwang27@163.com; XingShi Chen, E-mail: chenxingshi2008@163.com
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Abstract

Background

Few of the previous studies of clinical high risk of psychosis (CHR) have explored whether outcomes other than conversion, such as poor functioning or treatment responses, are better predicted when using risk calculators. To answer this question, we compared the predictive accuracy between the outcome of conversion and poor functioning by using the NAPLS-2 risk calculator.

Methods

Three hundred CHR individuals were identified using the Chinese version of the Structured Interview for Prodromal Symptoms. Of these, 228 (76.0%) completed neurocognitive assessments at baseline and 199 (66.3%) had at least a 1-year follow-up assessment. The latter group was used in the NAPLS-2 risk calculator.

Results

We divided the sample into two broad categories based on different outcome definitions, conversion (n = 46) v. non-conversion (n = 153) or recovery (n = 138) v. poor functioning (n = 61). Interestingly, the NAPLS-2 risk calculator showed moderate discrimination of subsequent conversion to psychosis in this sample with an area under the receiver operating characteristic curve (AUC) of 0.631 (p = 0.007). However, for discriminating poor functioning, the AUC of the model increased to 0.754 (p < 0.001).

Conclusions

Our results suggest that the current risk calculator was a better fit for predicting a poor functional outcome and treatment response than it was in the prediction of conversion to psychosis.

Keywords

Follow-uppredictionrisk calculatortransitionultra-high risk
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 9 , July 2020 , pp. 1578 - 1584
Copyright
Copyright © Cambridge University Press 2019

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Footnotes

*

This author shares first authorship.

†

Co-corresponding author.

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