Short-term functional outcome and premorbid adjustment in clinical high-risk patients. Results of the EPOS project.

In patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their childhood to adolescence premorbid adjustment. In all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganised, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9-month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analysed. During the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 74% to 37%. Poor premorbid adjustment, single marital status, poor work status, and symptoms were associated with low baseline GAF scores. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model. A great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are carried out.

Salokangas RK ，Heinimaa M ，From T ，Löyttyniemi E ，Ilonen T ，Luutonen S ，Hietala J ，Svirskis T ，von Reventlow HG ，Juckel G ，Linszen D ，Dingemans P ，Birchwood M ，Patterson P ，Schultze-Lutter F ，Ruhrmann S ，Klosterkötter J ，EPOS group ... -  《-》

Short-term functional outcome in psychotic patients: results of the Turku early psychosis study (TEPS).

Functional recovery of patients with clinical and subclinical psychosis is associated with clinical, neuropsychological and developmental factors. Less is known about how these factors predict functional outcomes in the same models. We investigated functional outcomes and their predictors in patients with first-episode psychosis (FEP) or a confirmed or nonconfirmed clinical high risk of psychosis (CHR-P vs. CHR-N). Altogether, 130 patients with FEP, 60 patients with CHR-P and 47 patients with CHR-N were recruited and extensively examined at baseline (T0) and 9 (T1) and 18 (T2) months later. Global Assessment of Functioning (GAF) at T0, T1 and T2 and psychotic, depression, and anxiety symptoms at T1 and T2 were assessed. Functional outcomes were predicted using multivariate repeated ANOVA. During follow-up, the GAF score improved significantly in patients with FEP and CHR-P but not in patients with CHR-N. A single marital status, low basic education level, poor work situation, disorganization symptoms, perceptual deficits, and poor premorbid adjustment in patients with FEP, disorganization symptoms and poor premorbid adjustment in patients with CHR-P, and a low basic education level, poor work situation and general symptoms in patients with CHR-N predicted poor functional outcomes. Psychotic symptoms at T1 in patients with FEP and psychotic and depression symptoms at T1 and anxiety symptoms at T2 in patients with CHR-P were associated with poor functioning. In patients with FEP and CHR-P, poor premorbid adjustment and disorganization symptomatology are common predictors of the functional outcome, while a low education level and poor work situation predict worse functional outcomes in patients with FEP and CHR-N. Interventions aimed at improving the ability to work and study are most important in improving the functioning of patients with clinical or subclinical psychosis.

Salokangas RKR ，From T ，Ilonen T ，Luutonen S ，Heinimaa M ，Armio RL ，Laurikainen H ，Walta M ，Paju J ，Toivonen A ，Jalo P ，Tuominen L ，Hietala J ... -  《-》

Anomalous self-experiences are strongly associated with negative symptoms in a clinical high-risk for psychosis sample.

Værnes TG ，Røssberg JI ，Møller P 《-》

Childhood trauma and premorbid adjustment among individuals at clinical high risk for psychosis and normal control subjects.

Traumatic childhood experiences are associated with psychotic illness and are frequently reported in patients at clinical high risk (CHR) for psychosis. Moreover, deteriorating premorbid functioning from childhood, and through adolescence, is related to greater severity of overall symptomatology and poorer outcomes in patients with psychosis. We studied the prevalence of traumatic childhood experiences and premorbid adjustment and their association with each other in patients at CHR for psychosis and normal control subjects (NCSs). A total of 20 CHR patients for psychosis and 30 NCSs aged 14 to 35 participated in the present study. The CHR patients were identified as prodromal to psychosis using the Structured Interview for Prodromal Syndromes/Scale of Prodromal Symptoms. Premorbid adjustment was assessed by using the premorbid adjustment scale (PAS), and self-reported childhood trauma was assessed with the Trauma and Distress Scale (TADS). In CHR patients, TADS and PAS scores were higher than in NCSs. In CHR patients, TADS correlated significantly with the PAS general section and observably, but not significantly, with adolescence and adulthood sections. CHR patients reported more childhood trauma experiences and poorer premorbid adjustment than NCSs. In CHR patients, traumatic childhood experiences are associated with poor general premorbid adjustment.

Tikka M ，Luutonen S ，Ilonen T ，Tuominen L ，Kotimäki M ，Hankala J ，Salokangas RK ... -  《-》

First-rank symptoms and premorbid adjustment in young individuals at increased risk of developing psychosis.

Morcillo C ，Stochl J ，Russo DA ，Zambrana A ，Ratnayake N ，Jones PB ，Perez J ... -  《-》