☆ 4.6 Article

Prognostic Accuracy of DSM-5 Attenuated Psychosis Syndrome in Adolescents: Prospective Real-World 5-Year Cohort Study

SCHIZOPHRENIA BULLETIN (2021)

Journal

SCHIZOPHRENIA BULLETIN

Volume 47, Issue 6, Pages 1663-1673

Publisher

OXFORD UNIV PRESS

DOI: 10.1093/schbul/sbab041

Keywords

psychosis; schizophrenia; CHR-P; risk; attenuated psychotic symptoms; prevention; adolescence

Funding

Italian Ministry of Education, University and Research (MIUR)
Italian Ministry of Health

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Abstract

The study suggests that DSM-5 APS has high sensitivity and reasonable accuracy in predicting long-term outcomes in adolescents at risk for psychosis. Patients in the DSM-5 APS group had more comorbid disorders and more severe symptoms compared to the non-APS group.

There is limited research in adolescents at risk for psychosis. The new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attenuated psychosis syndrome (DSM-5 APS) criteria have not been validated in this group. We conducted a RECORD-compliant, real-world, prospective, 5-year cohort study addressing clinical profile, transition to psychosis, and prognostic accuracy of DSM-5 APS in help-seeking inpatient/outpatient adolescents accessing Children and Adolescent Neuropsychiatric services at IRCCS Mondino Foundation (Pavia, Lombardy, Italy) between 2012 and 2019. About 243 adolescents (31 early-onset psychosis [EOP]; 110 meeting DSM-5 APS criteria, DSM-5 APS; 102 not meeting psychotic or DSM-5 APS criteria, non-APS) were included. At baseline, DSM-5 APS adolescents (aged 15.4 +/- 1.6) had on average 2.3 comorbid disorders (higher than EOP/non-APS, P < .001). DSM-5 APS adolescents had an intermediate psychopathological profile between non-APS/EOP (P < .001) and worsen Clinical Global Impression-Severity than non-APS (P < .001). DSM-5 APS functioning was intermediate between non-APS and EOP. 39.1% of DSM-5 APS were treated with psychotropic drugs (average = 64 days); 53.6% received psychotherapy. Follow-up of DSM-5 APS and non-APS groups lasted 33 and 26 months, respectively (median). The cumulative risk of transition at 1-5 years was 13%, 17%, 24.2%, 26.8%, and 26.8% in the DSM-5 APS group, 0%, 0%, 3.2%, 3.2%, and 3.2% in the non-APS group. The 5-year prognostic accuracy of the DSM-5 APS in adolescent was adequate (area under the curve = 0.77; Harrell's C = 0.736, 95%CI 0.697-0.775), with high sensitivity (91.3%) and suboptimal specificity (63.2%). The DSM-5 APS diagnosis can be used to detect help-seeking adolescents at risk of psychosis and predict their long-term outcomes. Future research should consolidate these findings.

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Symptoms of Attenuated Psychosis Syndrome in Relatives of Clinical High-Risk Youth: Preliminary Evidence

Sarah Tarbox-Berry, Barbara C. Walsh, Michael F. Pogue-Geile, Scott W. Woods

Summary: This study presents the first data on APS symptoms in family members of APS patients, showing that the severity of symptoms is greater in probands compared to siblings, especially in the negative/anxiety and positive factors. These results support the importance of non-familial effects on risk for APS and suggest differences in familial contribution to APS symptoms.

SCHIZOPHRENIA BULLETIN (2023)