Abstract
BackgroundSchizotypal disorder has been linked to conversion to schizophrenia, with a quarter to half of patients converting over a course of two to five years. Substance use disorders are common in patients with schizotypal disorder, and cannabis has been shown to be a risk factor for developing schizotypal disorder. Cannabis has also been linked to an increased risk of schizophrenia. Other substance use disorders, in particular alcohol, may also increase risk of later schizophrenia. These previous results suggest that substance use, in particular cannabis, may predict conversion to schizophrenia in people with schizotypal disorder.MethodsWe used the nationwide, unselected Danish registers. The study population was all people born since 1981 in Denmark with incident diagnosis of schizotypal disorder, without previous diagnosis of schizophrenia. Information on substance use disorders was combined from five different registers. Cox regression using time-varying information on substance use disorders and antipsychotic medication, and adjusted for parental history of mental disorders, sex, birth year, and calendar year were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).ResultsAfter two years, 16.3% (95% CI 14.8%-17.8%) of the people with schizotypal disorder had converted to schizophrenia. After 20 years, the conversion rate was 33.1% (95% CI 29.3–37.3) overall, and 58.2% (95% CI 44.8%-72.2%) in those with cannabis use disorders. In fully adjusted models, any substance use disorder predicted conversion to schizophrenia (HR=1.34, 95% CI 1.11–1.63). Dividing by substances, cannabis use disorders (HR=1.30, 95% CI 1.01–1.68), amphetamine use disorders (HR=1.90, 95% CI 1.14–3.17), and opioid use disorders (HR=2.74, 95% CI 1.38–5.45) predicted conversion to schizophrenia. These associations were not explained by concurrent use of antipsychotic medication, functional level before incident schizotypal disorder, or parental history of mental disorders.DiscussionSubstance use disorders, in particular cannabis, amphetamines, and opioids, are important predictors of conversion from schizotypal disorder to schizophrenia. However, conversion rates are high even in those without substance use disorders, indicating a need for both universal and substance-targeted prevention in people with schizotypal disorder.
Highlights
Neurocognitive impairments are a core feature of psychosis and major depressive disorder (MDD) and are associated with poorer functioning outcomes in these illnesses
The aim of this study was to examine neurocognitive functioning in UHR participants at baseline and whether neurocognitive performance is associated with i) transition to psychosis; ii) depressive disorder; and iii) functioning at medium-term follow-up
After adjustment for IQ and baseline functioning, functional outcomes at 6, 12 and 24 months were predicted by baseline Processing Speed. These findings suggest that neurocognitive abilities are important predictors of transition to psychosis and functional outcomes within the UHR population, but hold minimal value in predicting MDD after controlling for history of MDD
Summary
NEUROCOGNITION IN ULTRA-HIGHRISK INDIVIDUALS AND RELATIONSHIP TO TRANSITION TO PSYCHOSIS, DEPRESSIVE DISORDER, AND FUNCTIONING: FINDINGS FROM THE NEURAPRO TRIAL Background: Neurocognitive impairments are a core feature of psychosis and major depressive disorder (MDD) and are associated with poorer functioning outcomes in these illnesses. Individuals at ultra-high risk (UHR) for psychosis have been shown to experience mild but significant cognitive impairments relative to healthy controls.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
