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Schizophrenia Bulletin 2003 29(4):717-728;
© 2003 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
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© Oxford University Press

The Assessment of "Prodromal Schizophrenia": Unresolved Issues and Future Directions

Todd Lencz, Ph.D., Christopher W. Smith, M.A., Andrea M. Auther, Ph.D., Christoph U. Correll, M.D. and Barbara A. Cornblatt, Ph.D.
Assistant Professor of Psychiatry, Albert Einstein College of Medicine Bronx, NY; Research Attending Psychologist, Department of Psychiatry Research, Zucker Hillside Hospital Glen Oaks, NY; and Associate Director, the Recognition and Prevention (RAP) Program of the Zucker Hillside Hospital and Schneider Children's Hospital Lake Success, NY
Clinical Coordinator, the RAP program
Assistant Psychologist, the RAP program
Research Psychiatrist, Department of Psychiatry Research, Zucker Hillside Hospital
Professor of Psychiatry, Albert Einstein College of Medicine; and Director, the RAP Program

Send reprint requests to Dr. T. Lencz, the RAP Program, 444 Lakeville Road, Suite 303, Lake Success, NY 11042; e-mail: lencz{at}lij.edu

Because of the novelty of research with clinical high risk ("prodromal") patients, many unresolved issues exist concerning how the prodromal state is defined and measured. Data are presented from the Recognition and Prevention (RAP) program at the Zucker Hillside Hospital to address several outstanding questions. Baseline attenuated positive symptoms were rated in 42 putatively prodromal patients in the RAP program using the Scale of Prodromal Symptoms (SOPS). Followup data of 6 months or more were available on 34 of these subjects; 9 of these (26.5%) developed psychotic disorders. Patients who developed psychosis had significantly higher SOPS positive symptom scores at baseline than those who did not. Various thresholds, using both total SOPS positive symptom scores and highest single item score, significantly predicted transition to psychosis, which calls into question appropriate cutoffs for the distinction between health, prodromal status, and psychosis. The SOPS positive symptom "conceptual disorganization" was found to be significantly related to disorganized behavior but not to other positive symptoms or to psychotic outcome, suggesting the importance of examining dimensions of psychopathology. The dimensional quantification of prodromal symptom severity may be an important direction for future studies of the assessment of at-risk states.

Keywords: Schizophrenia / prodrome / clinical high risk / positive symptoms / psychosis / disorganization / predictive validity


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