Premorbid functional development and conversion to psychosis in clinical high-risk youths

Abstract

Deterioration in premorbid functioning is a common feature of schizophrenia, but sensitivity to psychosis conversion among clinical high-risk samples has not been examined. This study evaluates premorbid functioning as a predictor of psychosis conversion among a clinical high-risk sample, controlling for effects of prior developmental periods. Participants were 270 clinical high-risk individuals in the North American Prodrome Longitudinal Study—I, 78 of whom converted to psychosis over the next 2.5 years. Social, academic, and total maladjustment in childhood, early adolescence, and late adolescence were rated using the Cannon–Spoor Premorbid Adjustment Scale. Early adolescent social dysfunction significantly predicted conversion to psychosis (hazard ratio = 1.30, p = .014), independently of childhood social maladjustment and independently of severity of most baseline positive and negative prodromal symptoms. Baseline prodromal symptoms of disorganized communication, social anhedonia, suspiciousness, and diminished ideational richness mediated this association. Early adolescent social maladjustment and baseline suspiciousness together demonstrated moderate positive predictive power (59%) and high specificity (92.1%) in predicting conversion. Deterioration of academic and total functioning, although observed, did not predict conversion to psychosis. Results indicate early adolescent social dysfunction to be an important early predictor of conversion. As such, it may be a good candidate for inclusion in prediction algorithms and could represent an advantageous target for early intervention.

Predictors of functional outcome in individuals at high clinical risk for psychosis at six years follow-up

“…The onset of psychosis is often characterized by a rapid decline in employment and in school performances (Harris et al, 2005), and working and educational difficulties are common presenting problems even in HR subjects. Unemployment is significantly higher in HR subjects at baseline compared to a matched local population living in the same area (Fusar-Poli et al, 2010), and difficulties in school performance such as poor grades, absence or exclusion from school (Ballon et al, 2007) are more common in these subjects and transition to psychosis can be predicted by a worse psychosocial functioning (Fusar-Poli et al, 2010;Tarbox et al, 2013;Walder et al, 2013;Valmaggia et al, 2013). Our results did not show positive, negative and disorganized symptoms to have predictive power for the functional outcome of HR subjects as previous studies did (Carrion et al, 2013;Eslami et al, 2011;Salokangas et al, 2014;Schlosser et al, 2012;Velthorst et al, 2013).…”

Trajectories of premorbid childhood and adolescent functioning in schizophrenia-spectrum psychoses: A first-episode study

“…Given converging evidence that there are substantial individual differences among first-episode patients in the course of premorbid functioning, programmatic research is needed to develop personalized approaches to the specific treatment needs of individuals with schizophrenia-spectrum psychoses. Developmental trajectory classification many also help improve identification of people at earlier clinical stages of schizophrenia-spectrum disorders, including the premorbid and prodromal stages (Tarbox et al, 2013), a necessary first step in developing interventions tailored for the unique needs of people at different clinical stages. Specifically, given the association between poor early premorbid adjustment and enduring negative symptoms in first-episode schizophrenia-spectrum psychoses, child- and adolescent-appropriate clinical interventions should be developed which target behaviors and skills contributing to poor social and academic adjustment.…”

Psychosis risk screening in clinical high-risk adolescents: A longitudinal investigation using the Child Behavior Checklist

“…Recent research findings underscore the need for adjunctive screening measures to aid in early detection of at-risk youth likely to develop psychosis (Simeonova et al, 2011; Tarbox et al, 2013). This is a high priority research domain, given the significance for the development of novel prevention and early intervention approaches in at-risk populations for the emergence of severe mental illness.…”