Twelve-month psychosis-predictive value of the ultra-high risk criteria in children and adolescents

Armando, M; Pontillo, M; De Crescenzo, F; Mazzone, L; Monducci, E; Lo Cascio, N; Santonastaso, O; Pucciarini, ML; Vicari, S; Schimmelmann, BG; Schultze-Lutter, F (2015). Twelve-month psychosis-predictive value of the ultra-high risk criteria in children and adolescents. Schizophrenia Research, 169(1-3), pp. 186-192. Elsevier 10.1016/j.schres.2015.10.033

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Objective

The validity of current ultra-high risk (UHR) criteria is under-examined in help-seeking minors, particularly, in children below the age of 12 years. Thus, the present study investigated predictors of one-year outcome in children and adolescents (CAD) with UHR status.
Method

Thirty-five children and adolescents (age 9–17 years) meeting UHR criteria according to the Structured Interview for Psychosis-Risk Syndromes were followed-up for 12 months. Regression analyses were employed to detect baseline predictors of conversion to psychosis and of outcome of non-converters (remission and persistence of UHR versus conversion).
Results

At one-year follow-up, 20% of patients had developed schizophrenia, 25.7% had remitted from their UHR status that, consequently, had persisted in 54.3%. No patient had fully remitted from mental disorders, even if UHR status was not maintained. Conversion was best predicted by any transient psychotic symptom and a disorganized communication score. No prediction model for outcome beyond conversion was identified.
Conclusions

Our findings provide the first evidence for the predictive utility of UHR criteria in CAD in terms of brief intermittent psychotic symptoms (BIPS) when accompanied by signs of cognitive impairment, i.e. disorganized communication. However, because attenuated psychotic symptoms (APS) related to thought content and perception were indicative of non-conversion at 1-year follow-up, their use in early detection of psychosis in CAD needs further study. Overall, the need for more in-depth studies into developmental peculiarities in the early detection and treatment of psychoses with an onset of illness in childhood and early adolescence was further highlighted.

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