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Schizophr Bull. 2017 Jan;43(1):48-56. doi: 10.1093/schbul/sbw151.

Diagnostic and Prognostic Significance of Brief Limited Intermittent Psychotic Symptoms (BLIPS) in Individuals at Ultra High Risk.

Author information

1
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; paolo.fusar-poli@kcl.ac.uk.
2
OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK.
3
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
4
Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
5
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
6
Department of Neurofarba, University of Florence, Florence, Italy.
7
Postgraduate School of Child Neuropsychiatry, University of Modena and Reggio Emilia, Modena, Italy.

Abstract

BACKGROUND:

Brief Limited Intermittent Psychotic Symptoms (BLIPS) are key inclusion criteria to define individuals at ultra high risk for psychosis (UHR). Their diagnostic and prognostic significance is unclear.

OBJECTIVES:

To address the baseline diagnostic relationship between BLIPS and the ICD-10 categories and examine the longitudinal prognostic impact of clinical and sociodemographic factors.

METHODS:

Prospective long-term study in UHR individuals meeting BLIPS criteria. Sociodemographic and clinical data, including ICD-10 diagnoses, were automatically drawn from electronic health records and analyzed using Kaplan-Meier failure function (1-survival), Cox regression models, bootstrapping methods, and Receiver Operating Characteristics (ROC) curve.

RESULTS:

Eighty BLIPS were included. At baseline, two-thirds (68%) of BLIPS met the diagnostic criteria for ICD-10 Acute and Transient Psychotic Disorder (ATPD), most featuring schizophrenic symptoms. The remaining individuals met ICD-10 diagnostic criteria for unspecified nonorganic psychosis (15%), mental and behavioral disorders due to use of cannabinoids (11%), and mania with psychotic symptoms (6%). The overall 5-year risk of psychosis was 0.54. Recurrent episodes of BLIPS were relatively rare (11%) but associated with a higher risk of psychosis (hazard ratio [HR] 3.98) than mono-episodic BLIPS at the univariate analysis. Multivariate analysis revealed that seriously disorganizing or dangerous features increased greatly (HR = 4.39) the risk of psychosis (0.89 at 5-year). Bootstrapping confirmed the robustness of this predictor (area under the ROC = 0.74).

CONCLUSIONS:

BLIPS are most likely to fulfill the ATPD criteria, mainly acute schizophrenic subtypes. About half of BLIPS cases develops a psychotic disorder during follow-up. Recurrent BLIPS are relatively rare but tend to develop into psychosis. BLIPS with seriously disorganizing or dangerous features have an extreme high risk of psychosis.

KEYWORDS:

BLIPS; CAARMS; UHR; brief psychosis; diagnosis; prevention; psychosis; risk; schizophrenia

PMID:
28053130
PMCID:
PMC5216865
DOI:
10.1093/schbul/sbw151
[Indexed for MEDLINE]
Free PMC Article

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