Dataset Information

Functional Capacity Assessed by the Map Task in Individuals at Clinical High-Risk for Psychosis.

ABSTRACT:

Objectives

Recent studies have recognized that signs of functional disability in schizophrenia are evident in early phases of the disorder, and, as a result, can potentially serve as vulnerability markers of future illness. However, functional measures in the psychosis prodrome have focused exclusively on real-world achievements, rather than on the skills required to carry-out a particular real-world function (ie, capacity). Despite growing evidence that diminished capacity is critical to the etiology of the established disorder, virtually no attention has been directed towards assessing functional capacity in the pre-illness stages. In the present study, we introduce the Map task, a measure to assess functional capacity in adolescent and young-adult high-risk populations.

Methods

The Map task was administered to 609 subjects at Clinical High-Risk (CHR) for psychosis and 242 Healthy Controls (HCs) participating in the North American Prodrome Longitudinal Study (NAPLS2). Subjects were required to efficiently complete a set of specified errands in a fictional town.

Results

CHR participants showed large impairments across major indices of the Map task, relative to the HCs. Most importantly, poor performance on the Map task significantly predicted conversion to psychosis, even after adjusting for age, IQ, clinical state, and other potential confounders.

Conclusions

To the best of our knowledge, the Map task is one of the first laboratory-based measures to assess functional capacity in high-risk populations. Functional capacity deficits prior to the onset of psychosis may reflect a basic mechanism that underlies risk for psychosis. Early intervention targeting this domain may help to offset risk and independently improve long-term outcome.

SUBMITTER: McLaughlin D

PROVIDER: S-EPMC4988745 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Functional Capacity Assessed by the Map Task in Individuals at Clinical High-Risk for Psychosis.

McLaughlin Danielle D Carrión Ricardo E RE Auther Andrea M AM Olvet Doreen M DM Addington Jean J Bearden Carrie E CE Cadenhead Kristin S KS Cannon Tyrone D TD Heinssen Robert K RK Mathalon Daniel H DH McGlashan Thomas H TH Perkins Diana O DO Seidman Larry J LJ Tsuang Ming T MT Walker Elaine F EF Woods Scott W SW Goldberg Terry E TE Harvey Philip D PD Cornblatt Barbara A BA

Schizophrenia bulletin 20160422 5

<h4>Objectives</h4>Recent studies have recognized that signs of functional disability in schizophrenia are evident in early phases of the disorder, and, as a result, can potentially serve as vulnerability markers of future illness. However, functional measures in the psychosis prodrome have focused exclusively on real-world achievements, rather than on the skills required to carry-out a particular real-world function (ie, capacity). Despite growing evidence that diminished capacity is critical t ...[more]

PMID: 27105902

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Project description: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.To develop a predictive model of functional (social and role) outcome in a clinical high-risk sample for psychosis.Prospective, naturalistic, longitudinal 3- to 5-year follow-up study.The Recognition and Prevention Program in New York, a research clinic located in the Zucker Hillside Hospital in New York.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.Neurocognitive and clinical assessment.The primary outcome variables were social and role functioning at the last follow-up visit.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.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.

Dataset Information

Functional Capacity Assessed by the Map Task in Individuals at Clinical High-Risk for Psychosis.

Objectives

Methods

Results

Conclusions

Publications

Functional Capacity Assessed by the Map Task in Individuals at Clinical High-Risk for Psychosis.

Similar Datasets

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