Abstract
Evidence suggests that environmental factors not only increase psychosis liability but also influence the prognosis and outcomes of psychotic disorders. We investigated temporal and cross-sectional associations of a weighted score of cumulative environmental liability for schizophrenia - the exposome score for schizophrenia (ES-SCZ) - with functioning in first-episode psychosis (FEP). Data were derived from the baseline and 1-month assessments of the Athens FEP Research Study that enrolled 225 individuals with FEP. The Global Assessment of Functioning (GAF) and the Personal and Social Performance Scale (PSP) were used to measure social, occupational, and psychological functioning. The ES-SCZ was calculated based on the previously validated method. ES-SCZ was associated with the total scores of GAF and PSP at baseline and 1-month assessments. These findings remained significant when accounting for several associated alternative explanatory variables, including other environmental factors (obstetric complications, migration, ethnic minority), clinical characteristics (duration of untreated psychosis, symptom severity, previous antipsychotic use), and family history of psychosis, demonstrating that the association between ES-SCZ and functioning is over and above other risk factors and cannot be explained by symptom severity alone. Functioning improved from baseline to 1-month assessment, but no significant ES-SCZ-by-time interaction was found on functioning, indicating that functioning changes were not contingent on ES-SCZ. Our findings suggest that rather than a predictor of functional improvement, ES-SCZ represents a stable severity indicator that captures poor functioning in early psychosis. Environmental risk loading for schizophrenia (ES-SCZ) can be beneficial for clinical characterization and incorporated into transdiagnostic staging models.
Highlights
Psychosis spectrum disorder is a complex syndrome with a wide variety of clinical representations that follow diverse illness trajectories and outcomes after the first episode of psychosis (FEP), ranging from complete remission to chronic course and significant functional impairment (Guloksuz & van Os, 2018)
The investigation of the association between exposome score for schizophrenia (ES-SCZ) and Global Assessment of Functioning (GAF) at baseline showed that ES-SCZ was associated with the GAF total score in model 1 that was adjusted for age, sex, and education [B = −2.29, p value = 0.011]
These findings remained significant even when accounting for several associated alternative explanatory variables including other environmental exposures that were previously associated with psychosis spectrum disorder, clinical characteristics such as duration of untreated psychosis (DUP) and symptom severity, as well as the family history of psychosis, demonstrating that the association between ES-SCZ and functioning is over and above other risk factors and cannot be explained by symptom severity solely
Summary
Psychosis spectrum disorder is a complex syndrome with a wide variety of clinical representations that follow diverse illness trajectories and outcomes after the first episode of psychosis (FEP), ranging from complete remission to chronic course and significant functional impairment (Guloksuz & van Os, 2018). Prognosticating psychosocial functioning trajectories can help improve outcomes by early individualized interventions targeting functional improvement To this end, efforts have recently been made to develop multivariate models prognosticating functional outcomes, as well as short-term clinical remission (Koutsouleris et al, 2018; Soldatos et al, 2021). ES-SCZ was associated with the total scores of GAF and PSP at baseline and 1-month assessments These findings remained significant when accounting for several associated alternative explanatory variables, including other environmental factors (obstetric complications, migration, ethnic minority), clinical characteristics (duration of untreated psychosis, symptom severity, previous antipsychotic use), and family history of psychosis, demonstrating that the association between ES-SCZ and functioning is over and above other risk factors and cannot be explained by symptom severity alone. Environmental risk loading for schizophrenia (ES-SCZ) can be beneficial for clinical characterization and incorporated into transdiagnostic staging models
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