Psychiatric comorbidity in individuals at‐risk for psychosis: Relationships with symptoms, cognition and psychosocial functioning

Abstract

Aim: Psychiatric comorbidity frequently occurs with at-risk mental state (ARMS) for psychosis. Its relationships with psychopathology, cognition and functioning, however, remain to be further clarified. We aimed to examine prevalence and correlates of psychiatric comorbidity, and its associations with psychosocial functioning and subjective quality-of-life (QoL) in a representative sample of Chinese ARMS individuals.Methods: One hundred ten help-seeking participants aged 15 to 40 years with ARMS were recruited from a specialized early psychosis service in Hong Kong. ARMS status was verified by comprehensive assessment of at-risk mental state (CAARMS).Comorbid Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition nonpsychotic psychiatric disorders at baseline were ascertained using diagnostic interview and medical record review. Assessments encompassing symptom profiles, psychosocial functioning, subjective QoL and a brief cognitive battery were conducted.Results: Forty-nine (44.5%) ARMS participants were diagnosed as having comorbid non-psychotic psychiatric disorders at baseline, primarily depressive and anxiety disorders. Binary multiple logistic regression analysis revealed that female gender, more severe depressive symptoms, higher suicidality and poorer global cognitive functioning were independently associated with comorbid diagnosis status. ARMS participants with psychiatric comorbidity displayed significantly more limited extended social networks and poorer subjective QoL than those without psychiatric comorbidity. Conclusion:Comorbid disorders were frequently observed in Chinese ARMS individuals, and were linked to poorer cognition and higher suicide risk. Our findings

Risk Assessment of Ocular Hypertension and the Use of Medication

“…Therefore, it might not be cavalier to suggest that a portion of these subjects might already have 'asymptomatic disease' (or preperimetric glaucoma) (Figure 3), and this damage was undetectable on stereoscopic photography, which was also suggested by Weinreb et al [11]. The ever-evolving OCT technology and the concepts of ONH assessment can provide valuable data and new parameters for further refinement of the existing risk calculator, for instance, integrating other factors of OHN and RNFL based on OCT measurement [22]. The glaucoma risk model needs refinement that involves the advancing OCT technologies and concepts in measuring VCDR.…”

“…The study showed that there was disagreement in VCDR measurements between the three methods. This disagreement also extended to their corresponding 5-year risk estimation of POAG development [22]. When the comparison was made on the Bland-Altman plots, the range of discrepancies tended to widen with increasing mean risk, especially beyond the estimated Figure 2.…”

“…For instance, there is a poor agreement in the optic disc measurements obtained from HRT and OCT [21]. A study that compared VCDR measurement obtained with OCT, HRT and stereophotography in untreated OHT patients showed that there were poor agreement and lack of interchangeability between different techniques [22]. This is due to the differences between the techniques in defining optic disc margin and optic disc cup.…”

“…The study that compared VCDR measured by OCT, HRT and stereophotography of the ONH in patients with untreated OHT also investigated how the degree of disagreement extended to their corresponding 5-year risk estimation when other risk factors were kept contant [22]. In the study, ONH images of 140 untreated OHT eyes (of 75 patients) were taken by fundus camera (stereoscopic images), OCT and HRT.…”

“…'Likely visual field progression' is the presence of three or more points on the GPA at <0.05 probability for change on three consecutive occasions, while 'possible visual field progression' is the same criterion but on only two consecutive occasions [44]. Optic disc progression was defined as the rate of neuroretinal rim loss exceeding 1% of baseline rim area/year on a minimum of five repeat HRT images, where this is equivalent to approximately twice the value of normal age-related rim area loss [22]. Following treatment escalation, there is a resetting of both the target IOP and visual field and optic disc baselines against which future assessments will be compared with.…”