Psychosis prediction and clinical utility in familial high-risk studies: selective review, synthesis, and implications for early detection and intervention.

TitlePsychosis prediction and clinical utility in familial high-risk studies: selective review, synthesis, and implications for early detection and intervention.
Publication TypeJournal Article
Year of Publication2013
AuthorsShah JL, Tandon N, Keshavan MS
JournalEarly Interv Psychiatry
Volume7
Issue4
Pagination345-60
Date Published2013 Nov
ISSN1751-7893
KeywordsEarly Diagnosis, Early Medical Intervention, Endophenotypes, Family Health, Humans, Longitudinal Studies, Predictive Value of Tests, Psychotic Disorders, Risk Factors
Abstract

AIM: Accurate prediction of which high-risk individuals will go on to develop psychosis would assist early intervention and prevention paradigms. We sought to review investigations of prospective psychosis prediction based on markers and variables examined in longitudinal familial high-risk (FHR) studies.METHODS: We performed literature searches in MedLine, PubMed and PsycINFO for articles assessing performance characteristics of predictive clinical tests in FHR studies of psychosis. Studies were included if they reported on one or more predictive variables in subjects at FHR for psychosis. We complemented this search strategy with references drawn from articles, reviews, book chapters and monographs.RESULTS: Across generations of FHR projects, predictive studies have investigated behavioural, cognitive, psychometric, clinical, neuroimaging and other markers. Recent analyses have incorporated multivariate and multi-domain approaches to risk ascertainment, with generally modest results.CONCLUSIONS: Although a broad range of risk factors has been identified, no individual marker or combination of markers can at this time enable accurate prospective prediction of emerging psychosis for individuals at FHR. We outline the complex and multi-level nature of psychotic illness, the myriad of factors influencing its development, and methodological hurdles to accurate and reliable prediction. Prospects and challenges for future generations of FHR studies are discussed in the context of early detection and intervention strategies.

DOI10.1111/eip.12054
Alternate JournalEarly Interv Psychiatry
PubMed ID23693118
Grant ListK02 MH001180 / MH / NIMH NIH HHS / United States
MH01180 / MH / NIMH NIH HHS / United States
MH64023 / MH / NIMH NIH HHS / United States
MH78113 / MH / NIMH NIH HHS / United States
R01 MH064023 / MH / NIMH NIH HHS / United States

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