Neurocognitive and Clinical Predictors of Long-Term Outcome in Adolescents at Ultra-High Risk for Psychosis: A 6-Year Follow-Up

Tim Ziermans,Patricia Schothorst,René Kahn,Mirjam Sprong,Herman Van Engeland,Sanne De Wit,Sarah Durston,Andrea Mechelli

doi:10.1371/journal.pone.0093994

Tim Ziermans, Patricia Schothorst + Show 6 more

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https://doi.org/10.1371/journal.pone.0093994

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Journal: PloS one	Publication Date: Apr 4, 2014
Citations: 98	License type: CC BY 4.0

Affiliation: Leiden University, University Medical Center Utrecht

Abstract

BackgroundMost studies aiming to predict transition to psychosis for individuals at ultra-high risk (UHR) have focused on either neurocognitive or clinical variables and have made little effort to combine the two. Furthermore, most have focused on a dichotomous measure of transition to psychosis rather than a continuous measure of functional outcome. We aimed to investigate the relative value of neurocognitive and clinical variables for predicting both transition to psychosis and functional outcome.MethodsForty-three UHR individuals and 47 controls completed an extensive clinical and neurocognitive assessment at baseline and participated in long-term follow-up approximately six years later. UHR adolescents who had converted to psychosis (UHR-P; n = 10) were compared to individuals who had not (UHR-NP; n = 33) and controls on clinical and neurocognitive variables. Regression analyses were performed to determine which baseline measures best predicted transition to psychosis and long-term functional outcome for UHR individuals.ResultsLow IQ was the single neurocognitive parameter that discriminated UHR-P individuals from UHR-NP individuals and controls. The severity of attenuated positive symptoms was the only significant predictor of a transition to psychosis and disorganized symptoms were highly predictive of functional outcome.ConclusionsClinical measures are currently the most important vulnerability markers for long-term outcome in adolescents at imminent risk of psychosis.

Highlights

A major aim of twenty-first century schizophrenia research is to optimize the prediction of psychosis onset to guide initiatives on early intervention
Based on recent meta-analytic evidence [12], we hypothesized (1) that neurocognitive functioning would be relatively impaired in ultra-high risk (UHR) individuals compared to typically developing controls (TDC), and (2) that for the UHR individuals, impairments in cognitive functioning would predict whether they later converted to psychosis (UHR-P) or not (UHR-NP), as well as long-term functional outcome [6,7]
As part of the goal was to predict transition to psychosis, their data from the previous follow-up were included in part of the analyses, resulting in a total of ten UHR adolescents who had converted to psychosis (UHR-P) (23.3%) individuals and 33 UHR-NP individuals

Summary

Introduction

A major aim of twenty-first century schizophrenia research is to optimize the prediction of psychosis onset to guide initiatives on early intervention. Based on recent meta-analytic evidence [12], we hypothesized (1) that neurocognitive functioning would be relatively impaired in UHR individuals compared to TDC, and (2) that for the UHR individuals, impairments in cognitive functioning would predict whether they later converted to psychosis (UHR-P) or not (UHR-NP), as well as long-term functional outcome [6,7]. It was expected (3) that the combination of neurocognitive and clinical parameters would provide the best prediction of long-term clinical outcome [13,14,15]. We aimed to investigate the relative value of neurocognitive and clinical variables for predicting both transition to psychosis and functional outcome

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Conclusion