P-1014 - Functional impairment as a criterion for ultra-high risk criteria can induce a critical loss of sensitivity

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• 作者：S. Ruhrmann¹ ; F. Schultze-Lutter¹ ; ² ; M. Bodatsch¹ ; D. Linszen³ ; ⁴ ; R.K.R. Salokangas⁵ ; M. Birchwood⁶ ; G. Juckel⁷ ; S. Lewis⁸ ; J. Klosterkö ; tter¹ ; European Prediction of Psychosis Study (EPOS) Group
• 刊名：European Psychiatry
• 出版年：2012
• 出版时间：2012
• 年：2012
• 卷：27
• 期：supp_S1
• 页码：1
• 全文大小：68 K

文摘

Background

Ultra-high risk (UHR) criteria are defined by attenuated and/or transient full-blown psychotic symptoms and/or a combination of genetic risk factor and deterioration of functioning. To achieve a higher predictive specificity and a clear threshold of clinical importance, functional impairment has been considered as an obligate part of all UHR criteria.

Method

In the European Prediction of Psychosis Study (EPOS)N = 37 participants converted to psychosis, n = 146 completed the whole 18-month follow-up period without conversion. Assessed by the Global Assessment of Functioning Scale, modified version (GAF-M), the following functional states were considered: Considered GAF-M: ¡Ü30 % /¡Ü10 % reduction of baseline scores related to highest scores in the previous year; scores ¡Ü70/¡Ü60.

Results

The GAF reduction criteria led to a very unfavorable loss of sensitivity, even, if only 10 % were demanded. This was accompanied by correspondingly unfavorable accuracy measures. Introducing functional impairment criteria defined by the current state reported to be predictive for psychiatric caseness (score ¡Ü 70) or to define serious impairment (score ¡Ü 60) (Kessler et al., 2002, 2003) kept sensitivity at a perfectly high level, yet did not produce any gain of specificity.

Discussion

These results were certainly be caused by the fact that the whole group showed already low GAF-M scores in the previous year. Thus, a functional impairment criterion proved not to be useful to improve prediction. However, a combination of APS or BLIPS with a ¡®clinical status¡¯ criterion of GAF-M ¡Ü 70 may be considerable to demonstrate a strong need for intervention.