Investigating Cognitive and Clinical Predictors of Real-Life Functioning, Functional Capacity, and Quality of Life in Individuals at Ultra-High Risk for Psychosis

Abstract

Abstract A substantial proportion of individuals at ultra-high risk (UHR) for psychosis show long-term functional impairments, which may have profound consequences for the individual and society. Finding predictors of these functional impairments is critical to inform on the individual’s functional prognosis and potentially develop targeted interventions. This study used data from 91 UHR individuals participating in a randomized, clinical trial, that were followed up at 12 months, to elucidate on clinical, neuro- and social-cognitive predictors of UHR individuals’ functional outcome in the domains of social- and role functioning, quality of life, and functional capacity. The proportion of UHR individuals showing a poor social- and role outcome at 12-month follow-up was 50% and 63%, respectively. Worse social outcome was predicted by higher levels of negative symptoms, reduced processing speed, and impaired baseline social functioning explaining 52% of the variance. Worse role outcome was predicted by impaired role functioning at baseline, explaining 25% of the variance. Quality of life impairments were predicted by better theory of mind explaining 4% of the variance, and functional capacity social skills deficits were predicted by impaired baseline social skills explaining 20% of the variance. Our findings indicate that processing speed and negative symptoms may contribute to social- and role-functioning deficits, and while aspects of social cognition may also relate to social- and role functioning, baseline-functional impairments seem to be a strong contributor to persistent impairments in functioning and quality of life. If replicated, our findings suggest the need for future studies investigating the effect of pro-functional interventions targeting baseline functioning and targeted cognitive domains in UHR.