Tool created for psychosis risk

Psychologists have attempted to predict the risk of psychosis in young people since the early 2000s. Recently, the National Institutes of Health funded a study to develop a unique tool to calculate this risk. Nine sites participated in the study, including Yale University and Beth Israel Deaconess Medical Center.

Tyrone D. Cannon, Ph.D., Clark L. Hull Professor of Psychology and Psychiatry at Yale University, has devoted a quarter century of his career in schizophrenia research to creating such a tool.

“Up to now, it has been dependent on finding people at risk with recent changes in psychological functioning and who have symptoms similar to what we see in schizophrenia,” he said.

“Changes in thinking, beliefs and perception, hearing voices, paranoia and believing that events in the world relate directly to the person are early emerging signs. In some people, there is progression to full blown psychosis. We are trying to develop the knowledge to predict who is likely to progress.”

Cannon and the other researchers developed a calculator that collects data on the severity of early symptoms, social and cognitive functioning, ability to quickly process information, family history, stress level and trauma exposure. A set of mathematical equations takes these variables and calculates the observed risk for conversion, Cannon said.

Variables used in prior studies have been predictive of psychosis. For this study, the researchers wanted to use risk factors that were easy to ascertain in a more standard setting, Cannon said.

“For example, we could have tried to use more test-based [factors] like an imaging study or a blood-based study, but they require a higher cost and access to special equipment and labs that are not necessarily available everywhere.”
Most important at this stage is that the tool offers a better approach for identifying patients best suited for study.

“You can maximize the focus and resources on the patient with the highest risk and who needs the most help. It gives a chance to avoid exposing people less likely to potential progression to the side effects of a new treatment,” said Cannon.

The calculator is designed for patients diagnosed with Attenuated Psychosis Risk Syndrome; administrators of the calculator must undergo special training, which is available at various sites, he added.

In standard practice the risk calculator will provide a rough benchmark for the degree of concern, noted Cannon. For instance, if a patient goes to his general practitioner and gets high readings on cholesterol and blood pressure, the physician issues cautions about the risks for heart attack.

Depending on the risk, the physician may advise lifestyle changes and/or medication, he added. “This tool will create this kind of level of concern,” Cannon said.

For patients whose risk is estimated to be quite high, the clinician will be alerted to engage the patient and his family in more intense monitoring.

“If symptoms worsen, the clinician can ratchet up treatment or move more quickly to recruit [the patient] into intervention,” Cannon said. “It’s not as clear whether the current treatment is preventative of psychosis, but there are some emerging suggestions to help the patient and family function. Whether they prevent another episode is another question.”