PMID- 25319445
OWN - NLM
STAT- MEDLINE
DCOM- 20150826
LR  - 20211021
IS  - 1435-1463 (Electronic)
IS  - 0300-9564 (Linking)
VI  - 122
IP  - 1
DP  - 2015 Jan
TI  - Towards indicated prevention of psychosis: using probabilistic assessments of 
      transition risk in psychosis prodrome.
PG  - 155-69
LID - 10.1007/s00702-014-1325-9 [doi]
AB  - The concept of indicated prevention has proliferated in psychiatry, and 
      accumulating evidence suggests that it may indeed be possible to prevent or delay 
      the onset of a first episode of psychosis though adequate interventions in 
      individuals deemed at clinical high risk (CHR) for such an event. One challenge 
      undermining these efforts is the relatively poor predictive accuracy of clinical 
      assessments used in practice for CHR individuals, often leading to diagnostic and 
      therapeutic uncertainty reflected in clinical guidelines promoting a 'watch and 
      wait' approach to CHR patients. Using data from published studies, and employing 
      predictive models based on the odds-ratio form of Bayes' rule, we simulated 
      scenarios where clinical interview, neurocognitive testing, structural magnetic 
      resonance imaging and electrophysiology are part of the initial assessment 
      process of a CHR individual (extended diagnostic approach). Our findings indicate 
      that for most at-risk patients, at least three of these assessments are necessary 
      to arrive at a clinically meaningful differentiation into high- intermediate-, 
      and low-risk groups. In particular, patients with equivocal results in the 
      initial assessments require additional diagnostic testing to produce an accurate 
      risk profile forming part of the comprehensive initial assessment. The findings 
      may inform future research into reliable identification and personalized 
      therapeutic targeting of CHR patients, to prevent transition to full-blown 
      psychosis.
FAU - Clark, Scott Richard
AU  - Clark SR
AD  - School of Medicine, Discipline of Psychiatry, Royal Adelaide Hospital, University 
      of Adelaide, 4th Floor, Eleanor Harrald Building, 5005, Adelaide, SA, Australia.
FAU - Schubert, Klaus Oliver
AU  - Schubert KO
FAU - Baune, Bernhard Theodor
AU  - Baune BT
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20141016
PL  - Austria
TA  - J Neural Transm (Vienna)
JT  - Journal of neural transmission (Vienna, Austria : 1996)
JID - 9702341
SB  - IM
MH  - Bayes Theorem
MH  - Databases, Bibliographic/statistics & numerical data
MH  - Disease Progression
MH  - Early Diagnosis
MH  - Humans
MH  - Predictive Value of Tests
MH  - *Prodromal Symptoms
MH  - Psychotic Disorders/*diagnosis/*prevention & control
MH  - Secondary Prevention
EDAT- 2014/10/17 06:00
MHDA- 2015/08/27 06:00
CRDT- 2014/10/17 06:00
PHST- 2014/05/29 00:00 [received]
PHST- 2014/10/08 00:00 [accepted]
PHST- 2014/10/17 06:00 [entrez]
PHST- 2014/10/17 06:00 [pubmed]
PHST- 2015/08/27 06:00 [medline]
AID - 10.1007/s00702-014-1325-9 [doi]
PST - ppublish
SO  - J Neural Transm (Vienna). 2015 Jan;122(1):155-69. doi: 10.1007/s00702-014-1325-9. 
      Epub 2014 Oct 16.