پیش بینی نتایج عملکرد در افراد در معرض خطر بالا برای روان پریشی بالینی در شش سال پیگیری
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|32018||2015||9 صفحه PDF||سفارش دهید||7770 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Psychiatric Research, Volume 65, June 2015, Pages 115–123
Background The long-term functional status of subjects at ultra high risk for psychosis (HR) is relatively under investigated. This study explores baseline predictors of long-term functional outcome in HR subjects who did not convert to psychosis during a 6 years follow-up period. Methods A total of 154 HR were followed up for an average of 6 years. The primary outcome variable was global assessment of functioning at the last follow-up visit as assessed with the Global Assessment of Functioning tool. A multinomial logistic regression was performed to identify potential predictors of functional outcome. Results Baseline and follow-up data on functioning was available for 92 HR. Twenty-four (43%) individuals who did not convert to psychosis reported poor functioning at follow-up. Baseline scores in the GAF (Exp(b) = 0.857; 95% CIs: 0.75/0.97), employment status (Exp(b) = 0.029; 95% CIs: 0.00/0.268), and CAARMS total scores (Exp(b) = 1.976; 95% CIs: 1.00/1.14) predicted functional outcome in HR subjects at 6 years. Conclusions Despite the preventive treatments received, many individuals who did not convert to full-blown psychosis in the longer term do not functionally remit. These individuals are lower functioning, unemployed and have higher symptom loading at the time of their presentation to the prodromal clinic. Our study suggests the need for innovative treatments targeting long term functional status beyond the prevention of psychosis onset in the HR population.
Schizophrenia and psychotic disorders continue to be debilitating and associated with lifelong impairment in social and role functioning (Clement et al., 2014). The duration of untreated psychosis has been proposed to strongly influence functional outcome (Perkins et al., 2005 and Hegelstad et al., 2012). Operationalized criteria to detect the presence of a putative prodromal stage for psychosis have been largely tested and used worldwide (Fusar-Poli et al., 2013b). These criteria are known as Ultra High Risk (UHR), Clinical High Risk (CHR), At Risk Mental States (ARMS) (hereafter referred as clinical high risk, HR) and allow the preventative identification of subjects with a 30% risk of developing psychosis over a two year period (Fusar-Poli et al., 2012), mostly schizophrenia spectrum psychoses (Fusar-Poli et al., 2013a). While much attention has traditionally been given to predict transition to psychosis, only few studies have investigated the functional status of HR subjects who do not convert at follow-up. Recently a meta-analysis of functioning in subjects at high risk for psychosis demonstrated that HR subjects had a very large impairment in functioning than HC, but only small to moderate better functioning than subjects with a frank diagnosis of psychosis (Fusar-Poli et al., 2015). Although available treatment may reduce the risk of psychosis onset (Stafford et al., 2013), their impact on long-term functional outcomes remains unclear, with previous evidence indicating that non-converting individuals may remain at a lower level of functioning than matched healthy comparisons (Addington et al., 2011). Moreover, where functional status of HR individuals at follow-up has been studied, most have focused on short-term periods (up to 24 months) (Jalbrzikowski et al., 2013, Niendam et al., 2007, Bearden et al., 2011, Eslami et al., 2011, Sabb et al., 2010, Salokangas et al., 2014 and Schlosser et al., 2012). To our knowledge there is no consensus regarding the definition of long-term observation period in the HR subjects, in this manuscript we have adopted a definition of long term follow-up of more than five years. Following this definition, relatively few studies assessed long term functional outcome (Lin et al., 2011, Velthorst et al., 2013, Carrion et al., 2013 and Ziermans et al., 2014). Previous studies have shown that functioning of at risk subjects is stable over time (Cornblatt et al., 2012) whereas others have found an improvement in non-converters particularly in the year following the identification (Addington et al., 2011). Moreover, functional outcomes appear to be independent from the psychosis status (Carrion et al., 2013). While a lot of effort has been made to identify predictors of conversion (Fusar-Poli et al., 2011 and Fusar-Poli et al., 2012c) so far not enough is known about the possible predictors of functional outcome. Evidence suggests that negative symptoms (Salokangas et al., 2014, Schlosser et al., 2012, Velthorst et al., 2013, Valmaggia et al., 2013 and Demjaha et al., 2012), mood/anxiety symptoms (Salokangas et al., 2014 and Velthorst et al., 2013) and motor disturbances (Carrion et al., 2013), as well as positive (Salokangas et al., 2014), and disorganized (Salokangas et al., 2014, Eslami et al., 2011, Carrion et al., 2013 and Demjaha et al., 2012) symptoms at baseline predict the functional outcome at follow-up. The presence of formal thought content disorders (Bearden et al., 2011) and basic symptoms (Salokangas et al., 2014) showed also a predictive action. In addition individuals with low functioning at follow up had poor premorbid adjustment and working status (Salokangas et al., 2014), an impaired reciprocal social behaviour (Jalbrzikowski et al., 2013) at baseline and a prolonged duration of the untreated ‘at risk’ symptoms (Fusar-Poli et al., 2009). So far not enough is known about the functional outcome of HR subjects who do not convert to psychosis in a longer period of time, which is crucial to test the predictive validity of HR construct against other competing approaches. The goal of the present study was to add evidence to the above by 1) establishing the proportion of non-converting HR individuals with a good functional outcome within the time frame of the study; and 2) identifying baseline predictors of functional outcome in these non-converting HR subjects.