Abstract
A substantial number of individuals with clinical high-risk (CHR) mental state do not transition to psychosis. However, regardless of future diagnostic trajectories, many of these individuals develop poor social and occupational functional outcomes. The levels of glutathione, a crucial cortical antioxidant, may track variations in functional outcomes in early psychosis and prodromal states. Thirteen clinical high-risk and 30 healthy control volunteers were recruited for a 7-Tesla magnetic resonance spectroscopy scan with a voxel positioned within the dorsal anterior cingulate cortex (ACC). Clinical assessment scores were collected to determine if any association was observable with glutathione levels. The Bayesian Spearman’s test revealed a positive association between the Social and Occupational Functioning Assessment Scale (SOFAS) and the glutathione concentration in the clinical high-risk group but not in the healthy control group. After accounting for variations in the SOFAS scores, the CHR group had higher GSH levels than the healthy subjects. This study is the first to use 7-Tesla magnetic resonance spectroscopy to test whether ACC glutathione levels relate to social and occupational functioning in a clinically high-risk group and offers preliminary support for glutathione levels as a clinically actionable marker of prognosis in emerging adults presenting with risk features for various severe mental illnesses.
Highlights
Introduction iationsEmerging adults with attenuated or brief and limited psychotic symptoms are said to be in a clinical high-risk (CHR) state that later develops into multiple diagnostic outcomes including schizophrenia, mood disorders, such as bipolar disorder, or a major depressive disorder [1,2]
Longitudinal studies indicate that a large proportion of individuals with CHR do not transition to psychosis (65–89% not psychotic over 2–10 years [3,4,5]) but have poor social and occupational outcomes (48% functionally impaired at 3–10 years [3,6])
The groups differed in the CAST scores, which were higher in the CHR group than in the healthy controls (HC) group (mode = 4.19, posterior proportion (PP) = 1.0), but not in the AUDIT—C scores
Summary
Emerging adults with attenuated or brief and limited psychotic symptoms are said to be in a clinical high-risk (CHR) state (or “at-risk or ultrahigh-risk” mental state) that later develops into multiple diagnostic outcomes including schizophrenia, mood disorders, such as bipolar disorder, or a major depressive disorder [1,2]. A substantial number of individuals with CHR develop poor long-term functional (i.e., social and occupational) outcomes irrespective of diagnostic transitions. Longitudinal studies indicate that a large proportion of individuals with CHR do not transition to psychosis (65–89% not psychotic over 2–10 years [3,4,5]) but have poor social and occupational outcomes (48% functionally impaired at 3–10 years [3,6]). While functional outcomes improve over time in CHR patients who have good functioning at the baseline, persistent deficits are seen in those who start with lower levels of functioning [4].
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