Moving Beyond Binary Psychosis Risk Prediction

Psychology alumni Victor Pokorny and Danielle Pratt argue in their paper, “Stop Counting Conversions—The Clinical High Risk for Psychosis Field Needs a New North Star,” that current studies of psychosis fall much too far into a binary.

The clinical high-risk framework seeks to identify individuals that are at elevated risk for developing psychosis later in life. However, past work has overwhelmingly focused on predicting psychosis as a binary: either a person develops psychosis, or they don’t. In their perspective piece, Pokorny and Pratt argue that this focus has limited the field, distilling complex and variable symptom profiles into an overly simplistic, fixed binary. Instead, they argue that the field needs to broaden its focus to predicting a wider array of outcomes such as social/occupational functioning and symptom severity trajectories over time. Doing so would help solve a number of problems that have plagued the field, such as declining conversion rates and relatively low positive predictive validity.