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Further examination of the reducing transition rate in ultra high risk for psychosis samples: The possible role of earlier intervention

Schizophrenia Research, Volume 174, Issue 1-3, July 2016, Pages 43 - 49



The rate of transition to psychotic disorder in ultra high risk (UHR) patients has declined in recent cohorts. The reasons for this are unclear, but may include a lead-time bias, earlier intervention, a change in clinical characteristics of cohorts, and treatment changes.


In this paper we examined the two possibilities related to reduction in duration of symptoms prior to clinic entry, i.e., lead-time bias and earlier intervention.


The sample consisted of all UHR research participants seen at the PACE clinic, Melbourne between 1993 and 2006 (N = 416), followed for a mean of 7.5 years (the ‘PACE 400’ cohort). Duration of symptoms was analysed by four baseline year time periods. Analysis of transition rate by duration of symptoms was restricted to more homogenous sub-samples (pre-1998 and pre-2001) in order to minimize confounding effects of change in patient characteristics or treatments. These cohorts were divided into those with a short and long duration of symptoms using a cut-point approach.


Duration of symptoms prior to entry did not reduce significantly between 1993 and 2006 (p = 0.10). The group with a short duration of symptoms showed lower transition rates and did not catch up in transition rate compared to the long duration of symptoms group.


These data suggest that, while earlier intervention or lead-time bias do not fully account for the declining transition rate in UHR cohorts, it appears that earlier intervention may have exerted a stronger influence on this decline than length of follow-up period (lead-time bias).

Keywords: Prodrome, Ultra high risk, Early intervention, Psychosis.


a Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Victoria, Australia

b Telethon Kids Institute, The University of Western Australia, Australia

c School of Psychology, University of Birmingham, Birmingham, UK

d Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK

Corresponding author at: Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia.