Nelson, B., Yuen, H. P., Wood, S. J., Lin, A., Spiliotacopoulos, D., Bruxner, A., Broussard, C., Simmons, M., Foley, D. L., Brewer, W. J., Francey, S. M., Amminger, G. P., Thompson, Andrew D., McGorry, Patrick D. and Yung, A. R. (2013) Long-term follow-up of a group at ultra high risk ("prodromal") for psychosis : the PACE 400 study. JAMA Psychiatry, 70 (8). pp. 793-802. doi:10.1001/jamapsychiatry.2013.1270 ISSN 2168-622X.

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Abstract

Importance:
The ultra high-risk (UHR) criteria were introduced to prospectively identify patients at high risk of psychotic disorder. Although the short-term outcome of UHR patients has been well researched, the long-term outcome is not known.
Objective:
To assess the rate and baseline predictors of transition to psychotic disorder in UHR patients up to 15 years after study entry.
Design:
Follow-up study of a cohort of UHR patients recruited to participate in research studies between 1993 and 2006.
Setting:
The Personal Assessment and Crisis Evaluation (PACE) clinic, a specialized service for UHR patients in Melbourne, Australia.
Participants:
Four hundred sixteen UHR patients previously seen at the PACE clinic.
Main outcome and measures:
Transition to psychotic disorder, as measured using the Comprehensive Assessment of At-Risk Mental States, Brief Psychiatric Rating Scale/Comprehensive Assessment of Symptoms and History, or state public mental health records.
Results:
During the time to follow-up (2.4-14.9 years after presentation), 114 of the 416 participants were known to have developed a psychotic disorder. The highest risk for transition was within the first 2 years of entry into the service, but individuals continued to be at risk up to 10 years after initial referral. The overall rate of transition was estimated to be 34.9% over a 10-year period (95% CI, 28.7%-40.6%). Factors associated with transition included year of entry into the clinic, duration of symptoms before clinic entry, baseline functioning, negative symptoms, and disorders of thought content.
Conclusions and relevance:
The UHR patients are at long-term risk for psychotic disorder, with the highest risk in the first 2 years. Services should aim to follow up patients for at least this period, with the possibility to return for care after this time. Individuals with a long duration of symptoms and poor functioning at the time of referral may need closer monitoring. Interventions to improve functioning and detect help-seeking UHR patients earlier also may be indicated.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Psychoses, Psychoses -- Treatment
Journal or Publication Title:	JAMA Psychiatry
Publisher:	American Medical Association
ISSN:	2168-622X
Official Date:	August 2013
Dates:	Date Event August 2013 Published October 2013 Available
Volume:	70
Number:	8
Page Range:	pp. 793-802
DOI:	10.1001/jamapsychiatry.2013.1270
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Funder:	National Health and Medical Research Council (Australia) (NHMRC) , Colonial Foundation Trust
Grant number:	350241 (NHMRC); 566529 (NHMRC); 1027532 (NHMRC); 359223 (NHMRC); 566593 (NHMRC)
Related URLs:	Publisher

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