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Characterizing Covariant Trajectories of Individuals at Clinical High Risk for Psychosis Across Symptomatic and Functional Domains.

ABSTRACT: OBJECTIVE:The authors sought to characterize differences in outcomes among help-seeking individuals at clinical high risk for psychosis by identifying covariant longitudinal patterns of symptoms and functioning. METHODS:Group-based multitrajectory modeling was applied to longitudinal ratings of four symptom domains (positive, negative, disorganized, general) and general functioning among clinical high-risk individuals in an initial discovery sample (N=422). An independent sample (N=133) was used to test replicability. RESULTS:Three trajectory groups were identified among clinical high-risk individuals in the discovery sample: group 1 (30%) exhibited substantial improvement across all domains, with half reaching positive outcomes for both functioning and positive symptoms; group 2 (49%) exhibited moderate impairments across domains, with approximately one-quarter meeting criteria for positive outcomes; the remaining participants (group 3; 22%) exhibited consistent levels of severe impairment across domains and did not experience positive outcomes. These trajectory groups and remission patterns were replicated in an independent sample. CONCLUSIONS:Replicable subgroups of help-seeking clinical high-risk cases can be ascertained based on distinctive profiles of change over time in symptoms and functioning. Within each of the three identified subgroups, similar patterns of change (i.e., rapid, moderate, or no improvement) were observed across the four symptom domains and functioning. This consistency of change over time across domains within each subgroup is a novel observation supporting the syndrome consistency of clinical high-risk symptoms and signs. The observed trajectory subgroups are suggestive of different degrees of need for clinical interventions, ranging from minimal or supportive for about one-third of cases to increasingly intensive among the remainder.

SUBMITTER: Allswede DM

PROVIDER: S-EPMC7002249 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Characterizing Covariant Trajectories of Individuals at Clinical High Risk for Psychosis Across Symptomatic and Functional Domains.

Allswede Dana M DM Addington Jean J Bearden Carrie E CE Cadenhead Kristin S KS Cornblatt Barbara A BA Mathalon Daniel H DH McGlashan Thomas T Perkins Diana O DO Seidman Larry J LJ Tsuang Ming T MT Walker Elaine F EF Woods Scott W SW Cannon Tyrone D TD

The American journal of psychiatry 20190906 2

<h4>Objective</h4>The authors sought to characterize differences in outcomes among help-seeking individuals at clinical high risk for psychosis by identifying covariant longitudinal patterns of symptoms and functioning.<h4>Methods</h4>Group-based multitrajectory modeling was applied to longitudinal ratings of four symptom domains (positive, negative, disorganized, general) and general functioning among clinical high-risk individuals in an initial discovery sample (N=422). An independent sample ( ...[more]

PMID: 31509005

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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.

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Characterizing Covariant Trajectories of Individuals at Clinical High Risk for Psychosis Across Symptomatic and Functional Domains.

Publications

Characterizing Covariant Trajectories of Individuals at Clinical High Risk for Psychosis Across Symptomatic and Functional Domains.

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