Schizophrenia Bulletin Advance Access published online on April 21, 2009
Schizophrenia Bulletin, doi:10.1093/schbul/sbp027
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Validity of the Prodromal Risk Syndrome for First Psychosis: Findings From the North American Prodrome Longitudinal Study
2 Department of Psychiatry, Yale University, New Haven, CT
3 Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
4 Department of Psychiatry, University of California, San Diego, CA
5 Departments of Psychology and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
6 Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY
7 Schizophrenia Spectrum Disorders Research Program, Division of Adult Translational Research, National Institute of Mental Health, Bethesda, MD
8 Department of Psychiatry, University of North Carolina, Chapel Hill, NC
9 Department of Psychiatry, Harvard Medical School, Boston, MA
10 Departments of Psychology and Psychiatry, Emory University, Atlanta, GA
1 To whom correspondence should be addressed; PRIME Prodromal Research Clinic, Department of Psychiatry, Yale University School of Medicine, 34 Park Street, New Haven, CT 06519; tel: 203-974-7038, fax: 203-974-7057, e-mail: scott.woods{at}yale.edu.
Treatment and prevention studies over the past decade have enrolled patients believed to be at risk for future psychosis. These patients were considered at risk for psychosis by virtue of meeting research criteria derived from retrospective accounts of the psychosis prodrome. This study evaluated the diagnostic validity of the prospective "prodromal risk syndrome" construct. Patients assessed by the Structured Interview for Prodromal Syndromes as meeting criteria of prodromal syndromes (n = 377) from the North American Prodrome Longitudinal Study were compared with normal comparison (NC, n = 196), help-seeking comparison (HSC, n = 198), familial high-risk (FHR, n = 40), and schizotypal personality disorder (SPD, n = 49) groups. Comparisons were made on variables from cross-sectional demographic, symptom, functional, comorbid diagnostic, and family history domains of assessment as well as on follow-up outcome. Prodromal risk syndrome patients as a group were robustly distinguished from NC subjects across all domains and distinguished from HSC subjects and from FHR subjects on most measures in many of these domains. Adolescent and young adult SPD patients, while distinct from prodromal patients on definitional grounds, were similar to prodromals on multiple measures, consistent with SPD in young patients possibly being an independent risk syndrome for psychosis. The strong evidence of diagnostic validity for the prodromal risk syndrome for first psychosis raises the question of its evaluation for inclusion in Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition).
Keywords: prodrome / risk syndrome / psychosis / schizophrenia / schizotypy