Abstract

Context: Indicated prevention is currently regarded as the most promising strategy to attenuate, delay, or even avert psychosis.Existing criteria need improvement in terms of specificity and individual risk assessment to allow for better targeted and earlier interventions.Objective: To develop a differential predictive clinical model of transition to first-episode psychosis.Design: Prospective multicenter, naturalistic field study with a total follow-up time of 18 months.Setting: Six early-detection outpatient centers in Germany, Finland, the Netherlands, and England.Participants: Two hundred forty-five help-seeking patients in a putatively prodromal state of psychosis according to either ultra-high-risk (UHR) criteria or the basic symptom-based criterion cognitive disturbances (COGDIS).Main Outcome Measure: Incidence of transition to psychosis.Results: At 18-month follow-up, the incidence rate for transition to psychosis was 19%.Combining UHR and COGDIS yielded the best sensitivity.A prediction model was developed and included positive symptoms, bizarre thinking, sleep disturbances, a schizotypal disorder, level of functioning in the past year, and years of education.With a positive likelihood ratio of 19.9, an area under the curve of 80.8%, and a positive predictive value of 83.3%, diagnostic accuracy was excellent.A 4-level prognostic index further classifying the general risk of the whole sample predicted instantaneous incidence rates of up to 85% and allowed for an estimation of time to transition.