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Prediction of Psychosis in Youth at High Clinical Risk: A Multisite Longitudinal Study in North America
Open accessAbstract
CONTEXT: Early detection and prospective evaluation of individuals who will develop schizophrenia or other psychotic disorders are critical to efforts to isolate mechanisms underlying psychosis onset and to the testing of preventive interventions, but existing risk prediction approaches have achieved only modest predictive accuracy. OBJECTIVES: To determine the risk of conversion to psychosis and to evaluate a set of prediction algorithms maximizing positive predictive power in a clinical high-risk sample. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal study with a 2 1/2-year follow-up of 291 prospectively identified treatment-seeking patients meeting Structured Interview for Prodromal Syndromes criteria. The patients were recruited and underwent evaluation across 8 clinical research centers as part of the North American Prodrome Longitudinal Study. MAIN OUTCOME MEASURE: Time to conversion to a fully psychotic form of mental illness. RESULTS: The risk of conversion to psychosis was 35%, with a decelerating rate of transition during the 2 1/2-year follow-up. Five features assessed at baseline contributed uniquely to the prediction of psychosis: a genetic risk for schizophrenia with recent deterioration in functioning, higher levels of unusual thought content, higher levels of suspicion/paranoia, greater social impairment, and a history of substance abuse. Prediction algorithms combining 2 or 3 of these variables resulted in dramatic increases in positive predictive power (ie, 68%-80%) compared with the prodromal criteria alone. CONCLUSIONS: These findings demonstrate that prospective ascertainment of individuals at risk for psychosis is feasible, with a level of predictive accuracy comparable to that in other areas of preventive medicine. They provide a benchmark for the rate and shape of the psychosis risk function against which standardized preventive intervention programs can be compared.
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“Given that unusual beliefs and thought content constitute risk for psychosis conversion (Cannon et al., 2008), the reduction of self-referencing might be another rationale for mindfulness-based psychosis prevention.”
From Schizotypy and mindfulness: Magical thinking without suspiciousness characterizes mindfulness meditators (2016) · cites this paper as Cannon et al., 2008
In the citing paper
“b) suspiciousness/paranoia carries a high predictive power for conversion to psychosis in high risk individuals, alongside genetic risk and unusual thought content (Cannon et al., 2008)”
From Schizotypy and mindfulness: Magical thinking without suspiciousness characterizes mindfulness meditators (2016) · cites this paper as Cannon et al., 2008
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Metadata
- Authors
- Cannon, T. D., Cadenhead, K., Cornblatt, B., Woods, S. W., Addington, J., Walker, E., Seidman, L. J., Perkins, D., Tsuang, M., McGlashan, T., & Heinssen, R.
- Affiliations
- University of California, Los Angeles (US)
- University of California San Diego (US)
- Zucker Hillside Hospital (US)
- Yale University (US)
- University of Toronto (CA)
- Emory University (US)
- Harvard University (US)
- University of North Carolina at Chapel Hill (US)
- National Institute of Mental Health (US)
- ORCID
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2008-01-01
- Volume
- 65
- Issue
- 1
- Pages
- 28
- ISSN
- 0003-990X (ISSN-L)
- PMC
- PMC3065347
- OpenAlex
- W2140824803
- Cited by
- 1,269
- References
- 68
- Citations by year
- 2026: 14 · 2025: 22 · 2024: 19 · 2023: 30 · 2022: 32 · 2021: 52 · 2020: 51 · 2019: 72 · 2018: 50 · 2017: 80 · 2016: 91 · 2015: 98 · 2014: 93 · 2013: 115 · 2012: 109
- FWCI
- 78.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000454)
- National Institute of Mental Health (K24MH076191, K23MH001905, U01MH082022, R01MH060720, U01MH082004, U01MH081944)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- psychosis prediction, clinical high risk for psychosis, schizophrenia, transition to psychosis, risk prediction algorithm, unusual thought content, social dysfunction, substance abuse, North American Prodrome Longitudinal Study
- MeSH terms
- Adolescent, Adult, Algorithms, Cognition, Female, Humans, Longitudinal Studies, Male, Paranoid Disorders, Predictive Value of Tests, Prognosis, Psychotic Disorders, Risk Factors, Schizophrenia, Social Behavior, Syndrome, Antipsychotic Agents, Substance-Related Disorders, Genetic Predisposition to Disease, Kaplan-Meier Estimate
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