Two-Year Clinical and Functional Outcomes of an Asian Cohort at Ultra-High Risk of Psychosis.

Chun Ting Chan,Swapna Verma,Lay Keow Lim,Mythily Subramaniam,Sarah Ann Tay,Edimansyah Abdin

doi:10.3389/fpsyt.2018.00758

Chun Ting Chan, Swapna Verma + Show 4 more

Open Access

https://doi.org/10.3389/fpsyt.2018.00758

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Abstract

Background: To determine the 2-year clinical and functional outcomes of an Asian cohort at ultra-high risk (UHR) of psychosis.Method: This was a longitudinal study with a follow-up period of 2 years on 255 help-seeking adolescents and young adults at UHR of psychosis managed by a multi-disciplinary mental health team in Singapore. Clients received case management, psychosocial, and pharmacological treatment as appropriate. Data comprising symptom and functional outcomes were collected over the observation period by trained clinicians and psychiatrists.Results: The 2-year psychosis transition rate was 16.9%, with a median time to transition of 168 days. After 2 years, 14.5% of the subjects had persistent at-risk symptoms while 7.5% developed other non-psychotic psychiatric disorders. 38.4% of the cohort had recovered and was discharged from mental health services. The entire cohort's functioning improved as reflected by an increase in the score of the Social and Occupational Functioning Assessment Scale during the follow-up period. Predictors to psychosis transition included low education level, baseline unemployment, a history of violence, and brief limited intermittent psychotic symptoms, while male gender predicted the persistence of UHR state, or the development of non-psychotic disorders.Conclusion: Use of the current UHR criteria allows us to identify individuals who are at imminent risk of developing not just psychosis, but also those who may develop other mental health disorders. Future research should include identifying the needs of those who do not transition to psychosis, while continuing to refine on ways to improve the UHR prediction algorithm for psychosis.

Highlights

Schizophrenia and related psychotic disorders impose significant social and economic burden on the patients and the society, with the World Health Organization estimating that the direct costs associated with schizophrenia to be about 2% of total health care expenditure [1].Detecting and managing persons at Ultra High-Risk (UHR) for psychosis was identified as a potential way to recognize persons at increased risk of developing a psychotic disorder
Outcome Ultra High Risk Psychosis to offer treatment to prevent the development of mental health disorders that may follow the prodromal phase
There are significant variations in the psychosis transition rates reported across studies [2,3,4,5,6,7,8] which may be affected by factors such as study design, subject characteristics and follow-up duration

Summary

Introduction

Schizophrenia and related psychotic disorders impose significant social and economic burden on the patients and the society, with the World Health Organization estimating that the direct costs associated with schizophrenia to be about 2% of total health care expenditure [1].Detecting and managing persons at Ultra High-Risk (UHR) for psychosis was identified as a potential way to recognize persons at increased risk of developing a psychotic disorder. Outcome Ultra High Risk Psychosis to offer treatment to prevent the development of mental health disorders that may follow the prodromal phase. Regardless, the common finding is that majority of UHR individuals do not develop a psychotic disorder [6, 10,11,12,13,14]. This has important implications regarding patient education, treatment provision, and service planning. To determine the 2-year clinical and functional outcomes of an Asian cohort at ultra-high risk (UHR) of psychosis

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