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Prediction of psychosis:
A step towards indicated prevention of schizophrenia.

Yung AR, Phillips LJ, McGorry PD, McFarlane CA, Francey S, Harrigan S, Patton GC, and Jackson HJ (1998).

British Journal of Psychiatry (Supplement) 172 (Suppl 33): 14-20.

Although there were only a small number of at-risk individuals in this sample, 40% of them made the transition from being at-risk for psychosis to being psychotic within a six month followup period. This high rate raises the question of whether specific early interventions—including antipsychotic medications and psychosocial intervention—should be targeted at individuals showing these at-risk symptoms, especially if their baseline testing scores indicate them to be particularly vulnerable. The fact that five of the eight individuals who became psychotic in this sample did so within the first month of followup further suggests that this period is one of particularly high risk. At the least, close followup of identified vulnerable individuals could minimize the duration of untreated psychosis, hence improving outcome for these individuals.

It has long been acknowledged that people who become psychotic often experience some changes in behavior in the period preceding the onset of psychosis; this period has been known as the prodrome. The goal of this study was to identify individuals experiencing prodromal symptoms and thus likely to become psychotic within a followup period, with the eventual goal of either preventing full-blown psychosis or minimizing their symptoms and disability.

The study recruited individuals with psychological features which seemed to indicate the presence of a prepsychotic symptoms, e.g., individuals at risk for psychosis. Individuals were recruited if they showed either "attenuated" or "transient" psychotic symptoms. The former was defined as the presence of ideas of reference, odd beliefs or magical thinking, perceptual disturbance, odd thinking and speech, paranoid ideation, or odd behavior or appearance, apparent for at least a week. "Transient" psychotic symptoms were identified in individuals who had already experienced psychotic symptoms—hallucinations, delusions, unusual thought content, suspiciousness or formal thought disorder—but whose symptoms had lasted less than a week and resolved spontaneously. In addition, the authors considered individuals who had a family history of a first-degree relative with a psychotic disorder, as well as individuals with schizotypal personality disorder as being at-risk for developing psychosis.

The authors hypothesized that the rate of transition to psychosis would be 20-30% of the cases over a 12-month period, and that people who became psychotic would display more aberrant results on testing measures than people who did not; furthermore, they did not expect the two groups to differ on baseline measures. In order to assess psychopathology, the authors administered the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS), the Hamilton Rating Scale for Depression (HRSD), and the mania rating scale. When admitted to the program, individuals also received the Quality of Life (QLS) scale and the Global Assessment of Functioning (GAF), both of which measure functioning and disability. All of these tests were administered before the development of frank psychosis.

The sample consisted of the first 20 people recruited into the study, who were followed for six months. At the end of the six months, eight individuals (40%) had become psychotic—five within the first month of followup, one between months three and four, and two between months five and six. This suggests that the first month after seeking help is a period of particularly high risk for at-risk individuals. Significantly, differences were found on baseline scores for the BPRS, HRSD, and GAF between the eight individuals who became psychotic and the 12 who did not. This suggests that testing measures that assess psychopathology and functioning can actually distinguish between individuals likely to become psychotic within a six-month period and individuals who are simply at-risk for psychosis.

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