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Schizophr Res. 2014 Sep;158(1-3):69-75. doi: 10.1016/j.schres.2014.06.022. Epub 2014 Jul 8.

Current status specifiers for patients at clinical high risk for psychosis.

Author information

1
Department of Psychiatry, Yale University, New Haven, CT, United States. Electronic address: scott.woods@yale.edu.
2
Department of Psychiatry, Yale University, New Haven, CT, United States.
3
Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
4
Department of Psychiatry, UCSD, San Diego, CA, United States.
5
Department of Psychology, Yale University, New Haven, CT, United States.
6
Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States.
7
Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD, United States.
8
Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States.
9
Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
10
Department of Psychiatry, UCSD, San Diego, CA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
11
Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, United States.

Abstract

BACKGROUND:

Longitudinal studies of the clinical high risk (CHR) syndrome for psychosis have emphasized the conversion vs non-conversion distinction and thus far have not focused intensively on classification among non-converters. The present study proposes a system for classifying CHR outcomes over time when using the Structured Interview for Psychosis-risk Syndromes and evaluates its validity.

METHOD:

The system for classifying CHR outcomes is referred to as "current status specifiers," with "current" meaning over the month prior to the present evaluation and "specifiers" indicating a set of labels and descriptions of the statuses. Specifiers for four current statuses are described: progression, persistence, partial remission, and full remission. Data from the North American Prodromal Longitudinal Study were employed to test convergent, discriminant, and predictive validity of the current status distinctions.

RESULTS:

Validity analyses partly supported current status distinctions. Social and role functioning were more impaired in progressive and persistent than in remitted patients, suggesting a degree of convergent validity. Agreement between CHR current statuses and current statuses for a different diagnostic construct (DSM-IV Major Depression) was poor, suggesting discriminant validity. The proportion converting to psychosis within a year was significantly higher in cases meeting progression criteria than in those meeting persistence criteria and tended to be higher than in those meeting full remission criteria, consistent with a degree of predictive validity.

DISCUSSION:

CHR syndrome current status specifiers could offer a potentially valid and useful description of current clinical status among non-converters. Study in additional samples is needed.

KEYWORDS:

Clinical high risk; Course of illness; Current status; Psychosis; Risk syndrome

PMID:
25012147
PMCID:
PMC4152558
DOI:
10.1016/j.schres.2014.06.022
[Indexed for MEDLINE]
Free PMC Article

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