Towards indicated prevention of psychosis: using probabilistic assessments of transition risk in psychosis prodrome

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dc.contributor.authorClark, S.
dc.contributor.authorSchubert, K.
dc.contributor.authorBaune, B.
dc.date.issued2015
dc.description.abstractThe concept of indicated prevention has proliferated in psychiatry, and accumulating evidence suggests that it may indeed be possible to prevent or delay the onset of a first episode of psychosis though adequate interventions in individuals deemed at clinical high risk (CHR) for such an event. One challenge undermining these efforts is the relatively poor predictive accuracy of clinical assessments used in practice for CHR individuals, often leading to diagnostic and therapeutic uncertainty reflected in clinical guidelines promoting a 'watch and wait' approach to CHR patients. Using data from published studies, and employing predictive models based on the odds-ratio form of Bayes' rule, we simulated scenarios where clinical interview, neurocognitive testing, structural magnetic resonance imaging and electrophysiology are part of the initial assessment process of a CHR individual (extended diagnostic approach). Our findings indicate that for most at-risk patients, at least three of these assessments are necessary to arrive at a clinically meaningful differentiation into high- intermediate-, and low-risk groups. In particular, patients with equivocal results in the initial assessments require additional diagnostic testing to produce an accurate risk profile forming part of the comprehensive initial assessment. The findings may inform future research into reliable identification and personalized therapeutic targeting of CHR patients, to prevent transition to full-blown psychosis.
dc.description.statementofresponsibilityScott Richard Clark, Klaus Oliver Schubert and Bernhard Theodor Baune
dc.identifier.citationJournal of Neural Transmission, 2015; 122(1):155-169
dc.identifier.doi10.1007/s00702-014-1325-9
dc.identifier.issn0300-9564
dc.identifier.issn1435-1463
dc.identifier.orcidClark, S. [0000-0003-1640-5611]
dc.identifier.orcidSchubert, K. [0000-0003-1690-0209]
dc.identifier.orcidBaune, B. [0000-0001-6548-426X]
dc.identifier.urihttp://hdl.handle.net/2440/91419
dc.language.isoen
dc.publisherSpringer Vienna
dc.rights© Springer-Verlag Wien 2014
dc.source.urihttps://doi.org/10.1007/s00702-014-1325-9
dc.subjectClinical high risk; Psychosis; Early detection; Early intervention; Risk prediction; Transition; Odds ratio; Bayes’ rule
dc.titleTowards indicated prevention of psychosis: using probabilistic assessments of transition risk in psychosis prodrome
dc.typeJournal article
pubs.publication-statusPublished

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