Validity of the prodromal risk syndrome for first psychosis: findings from the North American Prodrome Longitudinal Study

Schizophr Bull. 2009 Sep;35(5):894-908. doi: 10.1093/schbul/sbp027. Epub 2009 Apr 21.


Treatment and prevention studies over the past decade have enrolled patients believed to be at risk for future psychosis. These patients were considered at risk for psychosis by virtue of meeting research criteria derived from retrospective accounts of the psychosis prodrome. This study evaluated the diagnostic validity of the prospective "prodromal risk syndrome" construct. Patients assessed by the Structured Interview for Prodromal Syndromes as meeting criteria of prodromal syndromes (n = 377) from the North American Prodrome Longitudinal Study were compared with normal comparison (NC, n = 196), help-seeking comparison (HSC, n = 198), familial high-risk (FHR, n = 40), and schizotypal personality disorder (SPD, n = 49) groups. Comparisons were made on variables from cross-sectional demographic, symptom, functional, comorbid diagnostic, and family history domains of assessment as well as on follow-up outcome. Prodromal risk syndrome patients as a group were robustly distinguished from NC subjects across all domains and distinguished from HSC subjects and from FHR subjects on most measures in many of these domains. Adolescent and young adult SPD patients, while distinct from prodromal patients on definitional grounds, were similar to prodromals on multiple measures, consistent with SPD in young patients possibly being an independent risk syndrome for psychosis. The strong evidence of diagnostic validity for the prodromal risk syndrome for first psychosis raises the question of its evaluation for inclusion in Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition).

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Comorbidity
  • Disability Evaluation
  • Disease Progression
  • Early Diagnosis
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Patient Acceptance of Health Care / psychology
  • Psychiatric Status Rating Scales / statistics & numerical data*
  • Psychometrics / statistics & numerical data
  • Psychotic Disorders / diagnosis*
  • Psychotic Disorders / genetics
  • Psychotic Disorders / psychology
  • Reproducibility of Results
  • Risk Assessment
  • Schizophrenia / diagnosis*
  • Schizophrenic Psychology*
  • Schizotypal Personality Disorder / diagnosis*
  • Schizotypal Personality Disorder / genetics
  • Schizotypal Personality Disorder / psychology
  • Social Adjustment
  • United States
  • Young Adult