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05-06-2013 | Mental health | Article

Close watch needed after ultra-high-risk psychosis diagnosis



medwireNews: About a third of people meeting the ultra-high-risk (UHR) criteria for psychosis will go on to develop a psychotic disorder, a study suggests.

"This is an important finding given the doubt expressed recently about the predictive value of the concept," write lead researcher Barnaby Nelson (University of Melbourne, Victoria, Australia) and colleagues in JAMA Psychiatry.

The highest rate of transitions was during the first 2 years after referral for UHR, so the team says that close monitoring of UHR patients should be focused within this time window. However, patients continued to develop psychotic disorders for up to 10 years after referral, suggesting that some form of long-term monitoring is also needed.

"This need for ongoing clinical care is underlined by the substantial death rate in the sample (2.2%), mainly due to suicide," say Nelson et al.

The team followed up 416 UHR patients, 114 of whom developed a psychotic disorder during a mean 7.5 years of follow up. The transition rate was 16.5% by the end of the first year after UHR referral and 20.4% by the end of the second year. After this, the transition rate continued to increase by about 4% per year, reaching 34.9% after 10 years of follow up. The latest transition occurred 9.7 years after UHR referral.

Two important predictors of transition to psychosis emerged from the study: duration of UHR symptoms and poor functioning.

Specifically, each additional year of symptoms prior to referral increased the likelihood for transition by 12%, which the researchers say "indicates the importance of detecting UHR patients and referring them to specialist services."

Poor functioning, as determined by Global Assessment of Functioning (GAF) score, was also associated with outcomes, such that a patient whose score was 10 points better than another's would have a 61% lower risk for transition.

This indicates the importance of intervening to improve patients' functioning "and not focusing solely on symptoms," say Nelson et al.

"Apart from being beneficial in its own right, it also may halt (over both the short and long term) the evolution of positive psychotic symptoms to the point of full threshold disorder," they comment.

But the team cautions: "It is also possible that poor functioning is an indicator or proxy of an underlying neurobiological process and may therefore be an early marker of poor prognosis, that is, it may indicate a deterioration process and that the onset of psychotic disorder has in fact already begun."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Eleanor McDermid, Senior medwireNews Reporter

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