High-risk youths need help regardless of psychosis conversion

By Eleanor McDermid, Senior medwireNews Reporter

Young people at clinical high risk for psychosis often have poor outcomes even if they do not actually develop psychosis, a study shows.

Fifteen of 92 patients (average age 16 years) followed up for an average of 3 years developed psychosis, and had generally poor outcomes, with 86.7% and 66.7% having poor social and role outcomes, respectively. However, the 77 who did not develop psychosis fared little better, with corresponding rates of 40.3% and 45.5%.

“These results emphasize the need for a flexible perspective on outcome in at-risk individuals,” say lead researcher Ricardo Carrión (Zucker Hillside Hospital, New York, USA) and co-workers.

Regardless of psychosis development, neurocognitive performance and functioning at baseline (relative to 68 mentally healthy controls) predicted long-term outcomes, with slightly different variables predicting social and role outcomes.

The independent predictors for poor social outcome were poor social functioning at baseline, along with impaired processing speed and a Scale of Prodromal Symptoms (SOPS) total disorganization subscale score higher than 4. These factors distinguished patients with and without poor social outcomes with a sensitivity of 72.7%, a specificity of 75.0%, and an overall accuracy of 82.4%.

Predictors for poor role outcome were poor baseline role functioning, as well as impaired verbal memory, and increased motor disturbances. These variables had a sensitivity of 62.2%, a specificity of 72.3%, and an overall accuracy of 77.0%.

“Our results demonstrate that a preventive approach to psychosis should be extended to include relevant functional outcomes, because these markers provided relevant discrimination between individuals with poor and good outcomes,” Carrión et al write in JAMA Psychiatry.

Adding conversion to psychosis to the models weakened the association between processing speed and social outcome. However, baseline social functioning and SOPS disorganization score continued to predict social outcome, and adding conversion to psychosis did not weaken the impact of the predictors of role outcomes.

“These adolescents and young adults are both at risk for psychosis and functional disability,” say the researchers. “Thus, prevention is needed for emerging psychosis, as well as for helping these individuals cope with persistent relationship and school/work difficulties.”

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