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Original Investigation |

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

Ricardo E. Carrión, PhD1,2; Danielle McLaughlin, MA1; Terry E. Goldberg, PhD1,2; Andrea M. Auther, PhD1; Ruth H. Olsen, BS1; Doreen M. Olvet, PhD1,2; Christoph U. Correll, MD1,2,3; Barbara A. Cornblatt, PhD, MBA1,2,3
[+] Author Affiliations
1Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore–Long Island Jewish Health System, Glen Oaks, New York
2Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, New York
3Department of Psychiatry and Molecular Medicine, Hofstra North Shore–LIJ School of Medicine, Hempstead, New York
JAMA Psychiatry. 2013;70(11):1133-1142. doi:10.1001/jamapsychiatry.2013.1909.
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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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