Abstract
Basic self-disturbance (BSD) is assumed to drive symptom development in schizophrenia spectrum disorders and in clinical high-risk (CHR) for psychosis. We investigated the relationship between BSD at baseline, assessed with the Examination of Anomalous Self-Experience (EASE), and symptoms and functional outcome after one year in 32 patients, including 26 CHR and six with non-progressive attenuated psychotic symptoms. Correlations between baseline BSD levels and positive, negative and disorganization symptoms, and global functioning level at follow-up were significant. Hierarchical regression analyses revealed that higher levels of baseline BSD predicted more severe positive symptoms and lower global functioning at follow-up, after adjusting for baseline positive symptoms and functioning. Subjects who were not in symptomatic and functional remission after one year had higher levels of BSD and negative symptoms, and lower functioning level, at baseline. Baseline BSD in participants with schizophrenia spectrum diagnoses at follow-up (9 of 12 were schizotypal personality disorder) were at the levels seen in schizotypal disorders in previous studies, but not significantly different from the other participants. Early identification and assessment of BSD may constitute a useful prognostic tool and a signal for therapeutic targets in CHR conditions. Further CHR studies investigating these relationships with larger samples are recommended.
Highlights
Criteria for clinical high-risk (CHR) for psychosis have been estab lished to predict and hopefully prevent a first episode of psychosis, and these criteria have increasingly been implemented in clinical research and practice during the last two decades (Fusar-Poli, 2017; Schultze- Lutter et al, 2015)
Examination of Anomalous Self-Experience (EASE) total at baseline explained a significant amount of the variance in SOPS positive (13 %) and Global Assessment of Functioning (GAF)-F scores (17 %) at follow-up, when controlling for baseline SOPS and GAF scores respec tively, but not of the variance in follow-up SOPS negative and SOPS disorganization scores. These results implied that higher baseline EASE total scores predicted higher SOPS positive and lower GAF-F scores at follow-up. This CHR study found that high levels of Basic self-disturbance (BSD) (EASE total score) at baseline were associated with a higher severity of SOPS positive, negative and disorganization symptoms, and more severe global dysfunction, at one-year follow-up
The significantly higher BSD level we found in non-remitting CHRpatients is compatible with findings in a seven-year follow-up study on a sample of patients with psychotic disorders
Summary
Criteria for clinical high-risk (CHR) for psychosis have been estab lished to predict and hopefully prevent a first episode of psychosis, and these criteria have increasingly been implemented in clinical research and practice during the last two decades (Fusar-Poli, 2017; Schultze- Lutter et al, 2015). The UHR criteria aims to detect imminent risk of psychosis, while the basic symptoms criteria were developed to detect risk of psychosis as early as possible in the development of the illness (Schultze-Lutter et al, 2015). Basic symptoms high-risk criteria involve subjectively experienced non-delusional changes and disturbances of thought and perception. They are defined and assessed with the Schizophrenia Proneness In strument, Adult (SPI-A) or Child & Youth version (SPI-CY), and include the cognitive-perceptive basic symptoms (COPER) and the cognitive disturbances (COGDIS) criteria (Schultze-Lutter et al, 2007). The COGDIS criteria have the strongest evidence-base regarding prediction of psychosis among these two sets of criteria (Schultze-Lutter et al, 2015)
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