Skip to main content

Advertisement

SpringerLink
Log in

Chances and risks of predicting psychosis

  • Review
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

Prevention is currently regarded a promising strategy for fighting the unfavorable consequences of psychosis. Yet, for the error probability inherent in any predictive approach, benefits and costs must be carefully weighed against each other. False attribution of risk may unnecessarily provoke stress and anxiety, and lead to unwarranted intervention exposure. However, clinical risk samples already exhibit psychopathological symptoms, cognitive and functional impairments, and help-seeking for mental problems. Thus, the risk of futile interventions is low as long as preventive measures also provide treatment for current complaints. Differentiation between still normal and clinically relevant mental states is another challenge as psychotic-like phenomena occur frequently in the general population, especially in younger adolescents. Reported prevalence rates vary with age, and if severe in terms of frequency and persistence, these phenomena considerably increase risk of psychosis in clinical as well as general population samples. Stigmatization is another concern, though insufficiently studied. Yet, at least more severe states of risk, which are accompanied by changes in thinking, feeling, and behavior, might lead to unfavorable, (self-) stigmatizing effects already by themselves, independent of any diagnostic “label,” and to stress and confusion for the lack of understanding of what is going on. To further improve validity of risk criteria, advanced risk algorithms combining multi-step detection and risk stratification procedures should be developed. However, all prediction models possess a certain error probability. Thus, whether a risk model justifies preventive measures can only be decided by weighing the costs of unnecessary intervention and the benefits of avoiding a potentially devastating outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Häfner H, van der Heiden W (2008) Course and outcome. In: Mueser KT, Jeste DV (eds) Clinical handbook of schizophrenia. The Guilford Press, New York, pp 100–113

    Google Scholar 

  2. Clouth J (2004) Kosten der Frühverrentung am Beispiel der Schizophrenie [Costs of early retirement—the case of schizophrenia]. Psychiatr Prax 31(Suppl 2):S238–S245

    Article  PubMed  Google Scholar 

  3. Rössler W et al (2005) Size of burden of schizophrenia and psychotic disorders. Eur Neuropsychopharmacol 15(4):399–409. doi:10.1016/j.euroneuro.2005.04.009

    Article  PubMed  Google Scholar 

  4. Brown S et al (2010) Twenty-five year mortality of a community cohort with schizophrenia. Br J Psychiatry 196(2):116–121. doi:10.1192/bjp.bp.109.067512

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gutiérrez-Maldonado J, Caqueo-Urízar A, Kavanagh D (2005) Burden of care and general health in families of patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 40(11):899–904

    Article  PubMed  Google Scholar 

  6. Gustavsson A et al (2011) Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21(10):718–779. doi:10.1016/j.euroneuro.2011.08.008

    Article  CAS  PubMed  Google Scholar 

  7. Tandon R, Nasrallah HA, Keshavan MS (2010) Schizophrenia, “just the facts” 5. Treatment and prevention. Past, present, and future. Schizophr Res 122(1–3):1–23. doi:10.1016/j.schres.2010.05.025

    Article  PubMed  Google Scholar 

  8. WHO (2004) Prevention of mental disorders: effective interventions and policy options. World Health Organization, Geneva

    Google Scholar 

  9. Ruhrmann S et al (2012) Pharmacological prevention and treatment in clinical at-risk states for psychosis. Curr Pharm Design 18(4):550–557

    Article  CAS  Google Scholar 

  10. Schultze-Lutter F et al (2007) Predicting first-episode psychosis by basic symptom criteria. Clin Neuropsychiatry 4(1):11–22

    Google Scholar 

  11. Schultze-Lutter F et al (2007) Schizophrenia proneness instrument—adult version (SPI-A). Giovanni Fioriti, Rome

    Google Scholar 

  12. McGlashan T, Walsh B, Woods SW (2010) The psychosis-risk syndrome. Handbook for diagnosis and follow-up. Oxford University Press, New York

    Google Scholar 

  13. Yung AR et al (2005) Mapping the onset of psychosis: the comprehensive assessment of At-Risk Mental States. Aust N Z J Psychiatry 39(11–12):964–971

    Article  PubMed  Google Scholar 

  14. van Os J, Rutten BP, Poulton R (2008) Gene-environment interactions in schizophrenia: review of epidemiological findings and future directions. Schizophr Bull 34(6):1066–1082. doi:10.1093/schbul/sbn117

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ruhrmann S, Schultze-Lutter F, Klosterkötter J (2010) Probably at-risk, but certainly ill–advocating the introduction of a psychosis spectrum disorder in DSM-V. Schizophr Res 120(1–3):23–37. doi:10.1016/j.schres.2010.03.015

    Article  PubMed  Google Scholar 

  16. Morrison AP et al (2012) Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial. BMJ 344:e2233. doi:10.1136/bmj.e2233

    Article  PubMed  PubMed Central  Google Scholar 

  17. Schultze-Lutter F et al (2012) “A rose is a rose is a rose”, but at-risk criteria differ. Pychopathology. doi:10.1159/000339208

  18. Yung AR et al (2007) Declining transition rate in ultra high risk (prodromal) services: dilution or reduction of risk? Schizophr Bull 33(3):673–681. doi:10.1093/schbul/sbm015

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fusar-Poli P et al (2012) Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatry 69(3):220–229. doi:10.1001/archgenpsychiatry.2011.1472

    Article  PubMed  Google Scholar 

  20. Kirkbride JB et al (2006) Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study. Arch Gen Psychiatry 63(3):250–258. doi:10.1001/archpsyc.63.3.250

    Article  PubMed  Google Scholar 

  21. Klosterkötter J et al (2001) Diagnosing schizophrenia in the initial prodromal phase. Arch Gen Psychiatry 58(2):158–164. doi:10.1001/archpsyc.58.2.158

    Article  PubMed  Google Scholar 

  22. Häfner H et al (1998) The ABC Schizophrenia Study: a preliminary overview of the results. Soc Psychiatry Psychiatr Epidemiol 33(8):380–386

    Article  PubMed  Google Scholar 

  23. Schultze-Lutter F et al (2010) Basic symptoms and ultrahigh risk criteria: symptom development in the initial prodromal state. Schizophr Bull 36(1):182–191. doi:10.1093/schbul/sbn072

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ruhrmann S, Schultze-Lutter F, Klosterkötter J (2010) Sub-threshold states of psychosis—a challenge to diagnosis and treatment. Clin Neuropsychiatry 7(2):72–87

    Google Scholar 

  25. McGlashan TH et al (2007) Recruitment and treatment practices for help-seeking “prodromal” patients. Schizophr Bull 33(3):715–726. doi:10.1093/schbul/sbm025

    Article  PubMed  PubMed Central  Google Scholar 

  26. Klosterkötter J, Schultze-Lutter F (2010) Prevention and early treatment. In: Helmchen H, Sartorius N (eds) Ethics in psychiatry: European contributions. Springer + Business Media B.V, Heidelberg, pp 235–262

    Chapter  Google Scholar 

  27. Bodatsch M et al (2011) Prediction of psychosis by mismatch negativity. Biol Psychiatry 69(10):959–966. doi:10.1016/j.biopsych.2010.09.057

    Article  PubMed  Google Scholar 

  28. Pukrop R, Ruhrmann S (2012) Neurocognitive indicators of high-risk states for psychosis. In: Borgwardt S, McGuire P, Fusar Poli P (eds) Vulnerability to psychosis :from neurosycience to psychopathology. Psychology Press, Hove, pp 73–94

    Google Scholar 

  29. Koutsouleris N et al (2009) Use of neuroanatomical pattern classification to identify subjects in at-risk mental states of psychosis and predict disease transition. Arch Gen Psychiatry 66(7):700–712. doi:10.1001/archgenpsychiatry.2009.62

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ruhrmann S et al (2008) Reduced subjective quality of life in persons at risk for psychosis. Acta Psychiatr Scand 117(5):357–368. doi:10.1111/j.1600-0447.2008.01152.x

    Article  CAS  PubMed  Google Scholar 

  31. APA (2010) DSM-V development: attenuated psychosis syndrome (proposed for section III of the DSM-5). http://www.dsm5.org/proposedrevision/Pages/proposedrevision.aspx?rid=412. Accessed 29 May 2012

  32. Ruhrmann S et al (2011) Negative symptoms and transition to a first episode of psychosis-findings from EPOS. Schizophr Bull 37:20–21

    Google Scholar 

  33. Addington J et al (2011) At clinical high risk for psychosis: outcome for nonconverters. Am J Psychiatry 168(8):800–805. doi:10.1176/appi.ajp.2011.10081191

    Article  PubMed  PubMed Central  Google Scholar 

  34. van Os J et al (2009) A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychol Med 39(2):179–195. doi:10.1017/S0033291708003814

    Article  PubMed  Google Scholar 

  35. Yung AR, McGorry PD (1996) The prodromal phase of first-episode psychosis: past and current conceptualizations. Schizophr Bull 22(2):353–370

    Article  CAS  PubMed  Google Scholar 

  36. van Os J et al (2000) Strauss (1969) revisited: a psychosis continuum in the general population? Schizophr Res 45(1–2):11–20. doi:10.1016/S0920-9964(00)90323-2

    PubMed  Google Scholar 

  37. Spauwen J et al (2003) Sex differences in psychosis: normal or pathological? Schizophr Res 62(1–2):45–49

    Article  PubMed  Google Scholar 

  38. Kendler KS et al (1996) Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The National Comorbidity Survey. Arch Gen Psychiatry 53(11):1022–1031

    Article  CAS  PubMed  Google Scholar 

  39. Kelleher I et al (2011) Identification and characterization of prodromal risk syndromes in young adolescents in the community: a population-based clinical interview study. Schizophr Bull. doi:10.1093/schbul/sbr164

  40. Kelleher I et al (2012) Clinicopathological significance of psychotic experiences in non-psychotic young people: evidence from four population-based studies. Br J Psychiatry 201:26–32. doi:10.1192/bjp.bp.111.101543

    Article  PubMed  Google Scholar 

  41. Schultze-Lutter F, Michel C, Schimmelmann BG (2012) Prevalence of at-risk criteria of psychosis in the general population: preliminary results from a telephone survey. Schizophr Res 136(Suppl 1):314

    Google Scholar 

  42. Schimmelmann BG, Michel C, SchultzeLutter F (2012) Psychopathological significance of at-risk criteria of psychosis in the general population: preliminary results from a telephone survey. Schizophr Res 136(Suppl 1):310

    Google Scholar 

  43. Schimmelmann BG, Walger P, Schultze-Lutter F (in press) Significance of prodromal symptoms of schizophrenia in childhood and adolescence. Can J Psychiatr

  44. Werbeloff N et al (2012) Self-reported attenuated psychotic symptoms as forerunners of severe mental disorders later in life. Arch Gen Psychiatry 69(5):467–475. doi:10.1001/archgenpsychiatry.2011.1580

    Article  PubMed  Google Scholar 

  45. Kaymaz N et al (2012) Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? Psychol Med 1–15. doi:10.1017/S0033291711002911

  46. Ochoa S et al (2008) What is the relative importance of self reported psychotic symptoms in epidemiological studies? Results from the ESEMeD–Catalonia Study. Schizophr Res 102(1–3):261–269. doi:10.1016/j.schres.2008.04.010

    Article  PubMed  Google Scholar 

  47. Schultze-Lutter F, Schimmelmann BG, Ruhrmann S (2011) The near Babylonian speech confusion in early detection of psychosis. Schizophr Bull 37(4):653–655. doi:10.1093/schbul/sbr039

    Article  PubMed  PubMed Central  Google Scholar 

  48. Grano N et al (2011) Differential results between self-report and interview-based ratings of risk symptoms of psychosis. Early Interv Psychiatry 5(4):309–314. doi:10.1111/j.1751-7893.2011.00266.x

    Article  PubMed  Google Scholar 

  49. Kendell R, Jablensky A (2003) Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry 160(1):4–12

    Article  PubMed  Google Scholar 

  50. Ben-Zeev D, Young MA, Corrigan PW (2010) DSM-V and the stigma of mental illness. J Ment Health 19(4):318–327. doi:10.3109/09638237.2010.492484

    Article  PubMed  Google Scholar 

  51. Welsh P, Tiffin PA (2011) Observations of a small sample of adolescents experiencing an at-risk mental state (ARMS) for psychosis. Schizophr Bull. doi:10.1093/schbul/sbr139

  52. Nordt C, Rössler W, Lauber C (2006) Attitudes of mental health professionals toward people with schizophrenia and major depression. Schizophr Bull 32(4):709–714. doi:10.1093/schbul/sbj065

    Article  PubMed  PubMed Central  Google Scholar 

  53. Gaebel W, Zaske H, Baumann AE (2006) The relationship between mental illness severity and stigma. Acta Psychiatr Scand Suppl 429:41–45. doi:10.1111/j.1600-0447.2005.00716.x

    Article  PubMed  Google Scholar 

  54. Penn DL, Kohlmaier JR, Corrigan PW (2000) Interpersonal factors contributing to the stigma of schizophrenia: social skills, perceived attractiveness, and symptoms. Schizophr Res 45(1–2):37–45

    Article  CAS  PubMed  Google Scholar 

  55. Corcoran C, Malaspina D, Hercher L (2005) Prodromal interventions for schizophrenia vulnerability: the risks of being “at risk”. Schizophr Res 73(2–3):173–184

    Article  PubMed  PubMed Central  Google Scholar 

  56. APA (2003) Diagnostisches und Statistisches Manual Psychischer Störungen-Textrevision (DSM-IV-TR). Hogrefe, Göttingen

    Google Scholar 

  57. Ruhrmann S et al (2010) Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study. Arch Gen Psychiatry 67(3):241–251. doi:10.1001/archgenpsychiatry.2009.206

    Article  PubMed  Google Scholar 

  58. Riecher-Rössler A et al (2009) Efficacy of using cognitive status in predicting psychosis: a 7-year follow-up. Biol Psychiatry 66(11):1023–1030. doi:10.1016/j.biopsych.2009.07.020

    Article  PubMed  Google Scholar 

  59. Job DE et al (2006) Grey matter changes can improve the prediction of schizophrenia in subjects at high risk. BMC Med 4:29

    Article  PubMed  PubMed Central  Google Scholar 

  60. Klosterkötter J et al (2011) Prediction and prevention of schizophrenia: what has been achieved and where to go next? World Psychiatry 10(3):165–174

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This article is part of the supplement “Personalized Psychiatry and Psychotherapy.” This supplement was not sponsored by outside commercial interests. It was funded by the German Association for Psychiatry and Psychotherapy (DGPPN).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University of Cologne, 50924, Cologne, Germany

    Stephan Ruhrmann, Joachim Klosterkötter, Mitja Bodatsch, Alexandra Nikolaides, Dominika Julkowski & Desire Hilboll

  2. University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland

    Frauke Schultz-Lutter

Authors
  1. Stephan Ruhrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joachim Klosterkötter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mitja Bodatsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexandra Nikolaides
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dominika Julkowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Desire Hilboll
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Frauke Schultz-Lutter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephan Ruhrmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ruhrmann, S., Klosterkötter, J., Bodatsch, M. et al. Chances and risks of predicting psychosis. Eur Arch Psychiatry Clin Neurosci 262 (Suppl 2), 85–90 (2012). https://doi.org/10.1007/s00406-012-0361-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-012-0361-4

Keywords

Search

Navigation