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Long-term follow-up of a group at ultra high risk ("prodromal") for psychosis : the PACE 400 study
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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
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Official URL: http://dx.doi.org/10.1001/jamapsychiatry.2013.1270
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 |
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| 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: |
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| 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 | ||||||
| Funder: | National Health and Medical Research Council (Australia) (NHMRC) , Colonial Foundation Trust | ||||||
| Grant number: | 350241 (NHMRC); 566529 (NHMRC); 1027532 (NHMRC); 359223 (NHMRC); 566593 (NHMRC) | ||||||
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