This article is more than 5 years old. Information may no longer be current.

Psychotic symptoms may predict later hospitalization

Psychotic symptoms were associated with later hospitalization for nonaffective psychotic disorders among Israeli military members aged 18 to 21 years; however, symptoms had low predictive value.

“Prospective studies attempting to identify and predict impending psychosis by following ‘high-risk’ or ‘prodromal’ individuals have proliferated in the past two decades. (The terms ‘prodromal’ and ‘ultra-high risk’ are often used interchangeably; here we use the term ‘prodromal’). The overwhelming majority of these studies have been conducted in specialized prodromal clinics, to which adolescents arrive via several sequential referral filters,” Abigail Livny, PhD, of Sheba Medical Center, Ramat Gan, Israel, and colleagues wrote. “If such findings could be generalized to primary psychiatric care, this would have substantial implications for early detection and early intervention in psychotic disorders.”

To characterize symptoms of individuals later hospitalized for psychotic disorders in primary mental health outpatient settings, researchers conducted a population-based historical prospective cohort study of national registers of clinical psychiatric services. The study cohort included 114,983 individuals aged 18 to 21 years who served in the Israeli military and were assessed in military mental health outpatient clinics over 72 months.

Overall, 0.95% (n = 1,092) of participants not diagnosed with a psychotic disorder at time of examination were hospitalized for nonaffective psychotic disorder up to 9 years after index examination.

Principal components analysis of symptoms presented at index examination indicated a symptom cluster of thought disorder, perceptual abnormalities, poor orientation and suicidality was associated with an increased risk for hospitalization for nonaffective psychotic disorder within 14 days after examination (HR = 45.8; 95% CI, 22.87-91.73); 15 to 111 days after examination (HR = 19.59, 95% CI, 13.08-29.33); 112 to 365 days after examination (HR = 4.94, 95% CI, 2.59–9.4); and 1 to 3.5 years after examination (HR = 3.42; 95% CI,2.21-5.28).

This symptom cluster was not associated with hospitalization 3.5 years or more after examination.

Despite increased risk, positive predictive values for the symptom cluster were low, ranging from 0.54% to 1.99%.

“The clinical setting of this study, characterized by a low threshold and high sensitivity to odd and unusual behaviors, and use of a population-based sample performing mandatory military service, coupled with free access to health care, point to the challenges of applying prediction algorithms or risk calculators outside the context of the specialized prodromal clinics in which they were developed,” the researchers concluded. – by Amanda Oldt

Disclosures: Livny reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.