Prediction of Functional Outcome in Individuals at Clinical High Risk for Psychosis

Abstract

IMPORTANCE A major public health concern associated with schizophrenia and psychotic disorders is the long-term disability that involves impaired cognition, lack of social support, and an inability to function independently in the community. A critical goal of early detection and intervention studies in psychosis is therefore to understand the factors leading to this often profound impairment.OBJECTIVE To develop a predictive model of functional (social and role) outcome in a clinical high-risk sample for psychosis.DESIGN Prospective, naturalistic, longitudinal 3-to 5-year follow-up study.SETTING The Recognition and Prevention Program in New York, a research clinic located in the Zucker Hillside Hospital in New York.PARTICIPANTS One hundred one treatment-seeking patients at clinical high risk for psychosis. Ninety-two (91%) were followed up prospectively for a mean (SD) of 3 (1.6) years. INTERVENTION Neurocognitive and clinical assessment. MAIN OUTCOMES AND MEASURESThe primary outcome variables were social and role functioning at the last follow-up visit. RESULTSPoor social outcome was predicted by reduced processing speed

Twelve-month psychosis-predictive value of the ultra-high risk criteria in children and adolescents

“…This sample bias can be considered both a strength and limitation of the study. (2) Only 5.6% of our sample had received any psychopharmacological treatment at baseline; this rate was much lower than the 41-49% medication rate reported by other adolescent UHR samples (Amminger et al, 2010;Carrión et al, 2013;Lindgren et al, 2014;Ziermans et al, 2011) allowing the observation of a more natural course. As any treatment seems to delay or prevent psychosis onset (van der Gaag et al, 2013), this low medication rate might have further contributed to both the high rate of BIPS and conversions.…”

“…This is partly in line with the only small 6-year improvement in global functioning of 33 adolescent non-converters whose UHR status at follow-up was not reported ). Yet, a 3-year follow-up study of 77 adolescent non-converters reported good role and social functioning outcomes (defined by a score of '7' or higher on GF:Role or GF:Social) in at least two thirds that were significantly related to better baseline functioning (Carrión et al, 2013), and, consequently, did not necessarily indicate significant functional improvement. Thus, functioning in adolescents might be more persistently affected than in older UHR samples, as improvement in non-converting mixed adult-adolescent samples within 3-6 years were significant, particularly within the first year (Lemos-Giráldez et al, 2009;Velthorst et al, 2011Velthorst et al, , 2013.…”

A Severity-Based Clinical Staging Model for the Psychosis Prodrome: Longitudinal Findings From the New York Recognition and Prevention Program

“…On their own, these abnormalities, which typically precede positive symptoms by several years, 24 have been shown to lead to various levels of functional disability. 25 However, according to this model, when combined with the additional predisposition (likely having an independent genetic etiology) to develop positive symptoms, then psychoses evolve. Therefore, critical to this model is the notion that there are 2 independent processes involved in developing a full-blown psychotic illness.…”

“…Therefore, critical to this model is the notion that there are 2 independent processes involved in developing a full-blown psychotic illness. The presence of either one alone can lead to poor long-term prognosis, 21,25 but the interaction between these 2 pathways is thought to lead to emergence of full-blown psychosis.…”

Neural Dysfunction in Cognitive Control Circuits in Persons at Clinical High-Risk for Psychosis

“…Neurocognitive abnormalities, particularly in cognitive control, may be a core feature of psychotic illness and predict its functional outcome (Snitz et al, 2006;Lesh et al, 2011;Carrion et al, 2011Carrion et al, , 2013Wood et al, 2003;Green, 1996). However, whether these cognitive phenomena are a cause of the illness, a consequence of it, or are an effect of disease chronicity, medication use, or other disease-related factors, is still unknown.…”