Environmental factors and social adjustment as predictors of a first psychosis in subjects at ultra high risk

BACKGROUND: The onset of schizophrenia is associated with genetic, symptomatic, social and environmental risk factors. The aim of the present study was to determine which environmental factors may contribute to a prediction of a first psychotic episode in subjects at Ultra High Risk (UHR) for developing psychosis. METHOD: We included 72 UHR subjects and followed them over a period of 36 months, of whom nineteen (26.4%) made a transition to psychosis. We applied survival analyses to determine associations between a transition to psychosis and environmental factors and social adjustment. To determine which items are the best predictors of transition to a first psychotic episode, Cox Regression analyses were applied RESULTS: Urbanicity, receiving state benefits and poor premorbid adjustment (PMA) significantly influenced the transition to psychosis. Urbanicity (Wald = 10.096, p = .001, HR = 30.97), social-sexual aspects (Wald = 8.795, p = .003, HR = 1.91) and social-personal adjustment (Wald = 10.794, p = .001, HR = 4.26) appeared to be predictors for developing psychosis in our UHR group. CONCLUSIONS: Environmental characteristics and social adjustment are predictive of transition to a psychosis in subjects at UHR. These characteristics should be implemented in a model for prediction of psychosis. Such a model would be more specific than current models and may lead to patient-specific preventive interventions. (C) 2010 Elsevier B.V. All rights reserve

Psychosis risk screening in routine mental health care

Background: Routine screening for psychosis risk in mental health care is not common practice. However, a systematic screening process might allow for the identification and treatment of UHR patients to prevent or delay psychosis. Furthermore, it may aid reducing DUP of undetected patients with a psychosis. But, is it possible to apply the criteria for ultra high risk for psychosis in populations with lower a priori probability of psychosis? Method: We used a two-stage screening procedure to screen all consecutive young adults, aged 18-35 years, who were help-seeking for nonpsychotic disorders (n = 3533) at the secondary mental health services in the Hague with a 16-item version of the Prodromal Questionnaire. Results: In the general help-seeking population, a cut-off score of 6 or more positively answered items on the 16-item version of the PQ has a high true positive rate (87%) and high specificity (87%) when differentiating UHR/psychosis from those with no Comprehensive Assessment of At-Risk Mental States (Yung et al., 2005) diagnosis. Conclusion: Young people with attenuated psychotic symptoms can be reliably identified in a general help-seeking population. The PQ-16 is recommended as routine screening tool in mental health care settings because it is feasible to screen large help-seeking populations

Psychosis risk screening in routine mental health care

Background: Routine screening for psychosis risk in mental health care is not common practice. However, a systematic screening process might allow for the identification and treatment of UHR patients to prevent or delay psychosis. Furthermore, it may aid reducing DUP of undetected patients with a psychosis. But, is it possible to apply the criteria for ultra high risk for psychosis in populations with lower a priori probability of psychosis? Method: We used a two-stage screening procedure to screen all consecutive young adults, aged 18-35 years, who were help-seeking for nonpsychotic disorders (n = 3533) at the secondary mental health services in the Hague with a 16-item version of the Prodromal Questionnaire. Results: In the general help-seeking population, a cut-off score of 6 or more positively answered items on the 16-item version of the PQ has a high true positive rate (87%) and high specificity (87%) when differentiating UHR/psychosis from those with no Comprehensive Assessment of At-Risk Mental States (Yung et al., 2005) diagnosis. Conclusion: Young people with attenuated psychotic symptoms can be reliably identified in a general help-seeking population. The PQ-16 is recommended as routine screening tool in mental health care settings because it is feasible to screen large help-seeking populations

Age of Onset of Cannabis Use Is Associated With Age of Onset of High-Risk Symptoms for Psychosis

Objective: Increasing interest in the prodromal stage of schizophrenia over the past decade led us to perform our study to monitor people at high risk for developing a psychosis. We hypothesized that cannabis use or a cannabis use disorder at a younger age relates to high-risk symptoms at a younger age. Method: People referred to the Academic Medical Centre in Amsterdam, the Netherlands, with an ultra-high risk (UHR) for psychosis were interviewed with the Composite International Diagnostic Interview to assess their cannabis consumption. The Interview for the Retrospective Assessment of the Onset of Schizophrenia was used to collect data about age of onset of high-risk or prodromal symptoms. Nine high-risk symptoms were selected and clustered because of their known relation with cannabis use. Results: Among the 68 included participants, 35 had used cannabis (51.5%), of whom 15 had used recently. Twenty-two participants had been cannabis abusers or cannabis-dependent (32.4%) in the past. Younger age at onset of cannabis use was related to younger age of onset of the cluster of symptoms (rho = 0.48, P = 0.003) and also to 6 symptoms individually (rho = 0.47 to 0.90, P <0.001 to 0.04). Younger age at onset of a cannabis use disorder was related to younger age of onset of the cluster of symptoms (rho = 0.67, P = 0.001) and also to 6 symptoms individually (rho = 0.50 to 0.93, P = 0.007 to 0.03). Conclusion: Cannabis use or a cannabis use disorder at a younger age in a group with an UHR for transition to psychosis is related to onset of high-risk symptoms for psychosis at a younger ag