Two-Year Clinical and Functional Outcomes of an Asian Cohort at Ultra-High Risk of Psychosis

Abstract

Background: To determine the 2-year clinical and functional outcomes of an Asian cohort at ultra-high risk (UHR) of psychosis.Method: This was a longitudinal study with a follow-up period of 2 years on 255 help-seeking adolescents and young adults at UHR of psychosis managed by a multi-disciplinary mental health team in Singapore. Clients received case management, psychosocial, and pharmacological treatment as appropriate. Data comprising symptom and functional outcomes were collected over the observation period by trained clinicians and psychiatrists.Results: The 2-year psychosis transition rate was 16.9%, with a median time to transition of 168 days. After 2 years, 14.5% of the subjects had persistent at-risk symptoms while 7.5% developed other non-psychotic psychiatric disorders. 38.4% of the cohort had recovered and was discharged from mental health services. The entire cohort's functioning improved as reflected by an increase in the score of the Social and Occupational Functioning Assessment Scale during the follow-up period. Predictors to psychosis transition included low education level, baseline unemployment, a history of violence, and brief limited intermittent psychotic symptoms, while male gender predicted the persistence of UHR state, or the development of non-psychotic disorders.Conclusion: Use of the current UHR criteria allows us to identify individuals who are at imminent risk of developing not just psychosis, but also those who may develop other mental health disorders. Future research should include identifying the needs of those who do not transition to psychosis, while continuing to refine on ways to improve the UHR prediction algorithm for psychosis.

Disturbances in White Matter Integrity in the Ultra-High-Risk Psychosis State—A Systematic Review

“…Due to the small sample size in most analyses, the results cannot be extrapolated to populations who are really at risk of developing full-blown psychosis. The initially available evidence suggested that 22–36% of UHR individuals convert to psychosis after 1–3 years [ 77 ], but the transition rates have been declining in more recent studies and vary between 16.9% after 2 years [ 78 ], 24% after 3 years [ 79 ], and 14.6% over a median follow-up time of 4.8 years [ 80 ], depending on the research; hence the need to conduct research on a large number of at-risk patients, possibly separately for the BLIPS, APS, and GDR subgroups. Analyses comparing UHR not only with HC but also FEP individuals or those recently diagnosed with schizophrenia suggest similar or less severe WM alterations in UHR relative to the other groups [ 34 , 43 , 48 , 53 , 81 , 82 ], which suggests that they may occur even prior to the onset of illness.…”

Using animal models for the studies of schizophrenia and depression: The value of translational models for treatment and prevention

“…Depression and schizophrenia share several genetic variations associated with these psychiatric disorders ( Brainstorm Consortium et al, 2018 ). Individuals at ultra-high risk for schizophrenia that do not transition to psychosis show an increased incidence of affective disorders and depression in adulthood ( Lin et al, 2015 ; Chan et al, 2018 ). The differences in susceptibility may be a product of interaction between genetic and environmental factors during a specific neurodevelopmental period ( Grace, 2016 ; Meyer and Lee, 2019 ).…”

Negative Symptoms and Functioning in Youth at Risk of Psychosis: A Systematic Review and Meta-analysis

“…10 In addition, CHR youth present with a wide range of negative symptom domains such as flat affect, alogia, anhedonia, avolition, and asociality. 13,14 CHR youth also present with deficits in global functioning, 15 deficits in social functioning 16 (i.e., level of social contact, friendships ) and deficits in role functioning (i.e., level of functioning at school or work) when compared to their non-psychiatric peers. 16 Moreover, negative symptoms have been shown to predict poor functioning in CHR more so than positive symptoms and despite established relationships between cognition and functioning in CHR, negative symptoms both mediate and are primary in this relationship [17][18][19][20] Both negative symptoms and functioning have been shown to reduce quality of life and impact long-term outcomes in CHR individuals, [21][22][23][24] thus a greater understanding of the association between negative symptoms and functioning in CHR youth may help with the development of more precise treatment targets.…”