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. 2013 Nov;70(11):1133-42.
doi: 10.1001/jamapsychiatry.2013.1909.

Prediction of functional outcome in individuals at clinical high risk for psychosis

Ricardo E Carrión  1 , Danielle McLaughlin, Terry E Goldberg, Andrea M Auther, Ruth H Olsen, Doreen M Olvet, Christoph U Correll, Barbara A Cornblatt
Affiliations

Prediction of functional outcome in individuals at clinical high risk for psychosis

Ricardo E Carrión et al. JAMA Psychiatry. 2013 Nov.

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 measures: The primary outcome variables were social and role functioning at the last follow-up visit.

Results: Poor social outcome was predicted by reduced processing speed (odds ratio [OR], 1.38; 95% CI, 1.050-1.823; P = .02), impaired social functioning at baseline (OR, 1.85; 95% CI, 1.258-2.732; P = .002), and total disorganized symptoms (OR, 5.06; 95% CI, 1.548-16.527; P = .007). Reduced performance on tests for verbal memory (OR, 1.74; 95% CI, 1.169-2.594; P = .006), role functioning at baseline (OR, 1.34; 95% CI, 1.053-1.711; P = .02), and motor disturbances (OR, 1.77; 95% CI, 1.060-2.969; P = .03) predicted role outcome. The areas under the curve for the social and role prediction models were 0.824 (95% CI, 0.736-0.913; P < .001) and 0.77 (95% CI, 0.68-0.87; P < .001), respectively, demonstrating a high discriminative ability. In addition, poor functional outcomes were not entirely dependent on the development of psychosis, because 40.3% and 45.5% of nonconverters at clinical high risk had poor social and role outcomes, respectively.

Conclusions and relevance: Results from this study support the increasing emphasis on functional decline as a critically important outcome that parallels conversion to psychosis and suggest that both psychosis and long-term functional disability are equally important targets for prevention. Reduced neurocognitive performance, functional impairments, and nonpositive attenuated symptoms at baseline were associated with an increased risk of poor functional outcomes in our sample. Poor functional outcomes were not entirely dependent on positive symptoms and the development of psychosis, further highlighting the need for intervention at this early stage of development for those who do and do not convert to a full-blown psychotic disorder.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Cornblatt was the original developer of the Continuous Performance Test, Identical Pairs version and has been an advisor for Merck. Dr Goldberg has received consulting fees from Merck and GlaxoSmithKline within the past year. He receives royalties for use of the Brief Assessment of Cognition in Schizophrenia in clinical trials. Dr Correll has been a consultant and/or advisor to or has received honoraria from Actelion, Alexza, American Academy of Child and Adolescent Psychiatry, AstraZeneca, Biotis, Bristol-Myers Squibb, Cephalon, Desitin, Eli Lilly, Gerson Lehrman Group, GlaxoSmithKline, IntraCellular Therapies, Lundbeck, MedAvante, Medscape, Merck, National Institute of Mental Health, Novartis, Ortho-McNeil/Janssen/Johnson & Johnson, Otsuka, Pfizer, ProPhase, Sunovion, Takeda, and Teva. He has received grant support from Bristol-Myers Squibb, Feinstein Institute for Medical Research, Janssen/Johnson & Johnson, National Institute of Mental Health, National Alliance for Research in Schizophrenia and Depression, and Otsuka. No other disclosures were reported.

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