Prediction and prevention of psychosis: current progress and future tasks

Ruhrmann, Stephan; Schultze-Lutter, Frauke; Schmidt, Stefanie Julia; Kaiser, Nathalie; Klosterkötter, Joachim (2014). Prediction and prevention of psychosis: current progress and future tasks. European archives of psychiatry and clinical neuroscience, 264(S1), pp. 9-16. Springer 10.1007/s00406-014-0541-5

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Prevention of psychoses has been intensively investigated within the past two decades, and particularly, prediction has been much advanced. Depending on the applied risk indicators, current criteria are associated with average, yet significantly heterogeneous transition rates of ≥30 % within 3 years, further increasing with longer follow-up periods. Risk stratification offers a promising approach to advance current prediction as it can help to reduce heterogeneity of transition rates and to identify subgroups with specific needs and response patterns, enabling a targeted intervention. It may also be suitable to improve risk enrichment. Current results suggest the future implementation of multi-step risk algorithms combining sensitive risk detection by cognitive basic symptoms (COGDIS) and ultra-high-risk (UHR) criteria with additional individual risk estimation by a prognostic index that relies on further predictors such as additional clinical indicators, functional impairment, neurocognitive deficits, and EEG and structural MRI abnormalities, but also considers resilience factors. Simply combining COGDIS and UHR criteria in a second step of risk stratification produced already a 4-year hazard rate of 0.66. With regard to prevention, two recent meta-analyses demonstrated that preventive measures enable a reduction in 12-month transition rates by 54-56 % with most favorable numbers needed to treat of 9-10. Unfortunately, psychosocial functioning, another important target of preventive efforts, did not improve. However, these results are based on a relatively small number of trials; and more methodologically sound studies and a stronger consideration of individual profiles of clinical needs by modular intervention programs are required

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > University Psychiatric Services > University Hospital of Child and Adolescent Psychiatry and Psychotherapy
04 Faculty of Medicine > University Psychiatric Services > University Hospital of Child and Adolescent Psychiatry and Psychotherapy > Research Division

UniBE Contributor:

Schultze-Lutter, Frauke and Schmidt, Stefanie Julia

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0940-1334

Publisher:

Springer

Language:

English

Submitter:

Nicole Jansen

Date Deposited:

29 Oct 2014 11:30

Last Modified:

11 Nov 2015 11:38

Publisher DOI:

10.1007/s00406-014-0541-5

PubMed ID:

25256263

BORIS DOI:

10.7892/boris.59664

URI:

https://boris.unibe.ch/id/eprint/59664

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