Factors Associated With Psychosocial Functioning and Outcome of Individuals With Recent-Onset Schizophrenia and at Ultra-High Risk for Psychosis

Abstract

Background: Patients with schizophrenia have impairments in social functioning and are readmitted to healthcare institutions frequently. Individuals at ultra-high risk (UHR) for psychosis already present poor social functioning; among those individuals, the conversion rate from the putative prodromal phase to overt psychosis is 20%–30% within 1–2 years. Here, we analyzed the factor structure of self-related variables and neuro- and socio-cognitive function, and investigated whether these factors were associated with psychosocial function and prognostic outcome in individuals with recent-onset schizophrenia (ROSPR) or at UHR for psychosis. Methods: We evaluated 60 individuals at UHR for psychosis, 47 individuals with ROSPR, and 71 healthy controls using a comprehensive neurocognitive test battery and self-reported attribution scales, self-esteem, resilience, aberrant subjective experiences of schizotypy (physical anhedonia, social anhedonia, magical ideation, and perceptual aberration), and basic symptoms. We assessed psychosocial function with the Quality of Life Scale (QLS). Results: Factor analysis of all subjects revealed a four-factor structure comprising social-cognitive bias, reflective self, neurocognition, and pre-reflective self factors. Multiple regression analysis at baseline revealed that the factor structure predicted QLS. In the UHR group, social-cognitive bias, reflective self, neurocognition, and negative symptoms were significant determinants, explaining 38.0% of total QLS score variance. In the ROSPR group, reflective self and negative symptoms were significant determinants, explaining 54.4% of total QLS score variance. During follow-up, 13 individuals at UHR for psychosis developed psychosis (cumulative prevalence: 31.2% ± 7.6% at 6 years), with neurocognition score at baseline remaining a significant predictor of conversion [χ 2 (1) = 4.009, p = 0.045; hazard ratio 0.56, 95% confidence interval 0.31–0.99, p = 0.048]. Five patients with schizophrenia were (re)admitted during follow-up (cumulative prevalence: 16.1% ± 7.1% at 6 years); no factor was found to predict (re)admission. Conclusion: Factor analysis revealed an intrinsic four-factor structure of social-cognitive bias, reflective self, neurocognition, and pre-reflective self. The four factors were associated with social functioning at baseline and prodrome-to-psychosis conversion during follow-up, indicating the clinical significance of the four-factor structure. These findings provide a framework for understanding schizophrenia.

Does mindfulness improve inhibitory control in psychotic disorders? A randomized controlled clinical trial

“…The importance of improving IC in people diagnosed with psychosis is well-recognized ( Cella and Wykes, 2019 , Kurtz et al, 2016 ). IC as measured using Stroop is correlated with quality of life in people experiencing psychoses ( Ojeda et al, 2019 ), with social functioning in prodromal psychosis and when diagnosis is confirmed ( Kim et al, 2019 ); and IC is identified as a key mechanism for improving social functioning in cognitive rehabilitation for psychosis ( Peña et al, 2018 ). Mindfulness training is known to enhance IC in other clinical and non-clinical groups ( Gallant, 2016 ), and is conceptualized to benefit people with psychosis by training them to recognize and let go of habitual reactions to psychotic sensations, such as aversion and avoidance ( Chadwick, Taylor, & Abba, 2005 ).…”

Functioning in community-dwelling patients with schizophrenia spectrum disorders in rural Greece

“…Higher resilience has been related to better social functioning (Poloni et al, 2018; Rossi et al, 2017), whereas anxiety as a trait was also found to impact daily functioning (Buonocore et al, 2019). Other self-related variables, such as social cognitive bias and reflective self, have been also associated with patients’ functioning (Kim et al, 2019). All these aspects of neurocognition may provide a framework for understanding schizophrenia and related disorders, and for individualization of treatment interventions.…”

Psychosis-like experiences and resilience: A systematic and critical review of the literature.

“…All 15 articles included a general population sample or subgroup. Four articles included a subgroup of individuals at CHR/UHR for psychosis, comprised of two unique clinical/helpseeking samples (Kim et al, 2013(Kim et al, , 2019Marulanda & Addington, 2016;Park et al, 2018) and one student sample (Shi et al, 2016).…”