Decline In Social Functioning Research Articles

Impact of loneliness and social isolation in older people in Japan

A decline in social functioning is a hallmark of dementia and is associated with worsening cognitive impairment, various behavioral and psychological symptoms, and caregiver burden. Since the feeling of loneliness is related to social function decline in people with mild cognitive impairment (MCI) and dementia, care for the social isolation that can cause loneliness is considered important in Japan, where the number of older people living alone is increasing.In addition to dementia, late-onset psychosis is also known to be affected by loneliness and social isolation. Psychosis that develops after age 60 and does not involve organic or affective disorders is defined as very late-onset schizophrenia-like psychosis (VLOSLP) and is known to be different in quality from psychosis that develops at a younger age. Social isolation has been reported as one of risk factors of VLOSLP, and although people with VLOSLP are independent in daily life, their social functioning is impaired in a way that is different from dementia due to their abnormalities in the content of thinking. Therefore, social isolation and decline of social functioning are also major problems for VLOSLP. Longitudinally, people with VLOSLP are more likely than the general older population to progress to dementia including Lewy body disease and Alzheimer’s disease subtypes. With the increasing importance of early diagnosis and intervention of these neurodegenerative diseases, identification and intervention of people with VLOSLP is a challenging but important topic.We are now investigating the use of robots with communication capabilities aiming to improve loneliness and social isolation of older people living alone with MCI, mild dementia and VLOSLP. On the other hand, we have found that loneliness in MCI and mild dementia does not necessarily correlate with social isolation status, such as living alone, indicating that loneliness and social isolation among older people requires further research.

Cognitive-Behavioral Social Skills Training: Outcome of a Randomized Controlled Trial for Youth at Risk of Psychosis.

Difficulties in social functioning have been observed in youth at clinical high-risk (CHR) of psychosis even in those who do not go on to develop a psychotic illness. Few treatment studies have attempted to improve social functioning in this population. The aim of this study was to conduct a randomized trial comparing the effects of Cognitive-Behavioral Social Skills Training (CBSST) with a supportive therapy (ST). Both CBSST and ST were weekly group therapies, delivered over 18 weeks. This was a 2-arm trial with single-blinded ratings and intention-to-treat analyses. Assessments occurred at baseline, end-of-treatment, and 12 months after the baseline assessment. The primary outcome was social and role functioning and defeatist performance attitudes were the secondary outcome. Attenuated positive and negative symptoms, anxiety, depression, self-efficacy, and beliefs about self and others were examined as exploratory outcomes. There were no significant differences between the 2 groups at baseline or either of the 2 follow-ups. However, at follow-ups, in each group there were significant improvements in clinical symptoms. These could not be attributed to group treatment since there was no control or wait-list group. Since poor social functioning is one of the most observed difficulties in CHR individuals, and a decline in social functioning may be a significant predictor of later transition to psychosis, future work will be needed to find effective treatments for this decline in functioning for CHR youth.

Clinical-correlative analysis of patients at risk of schizophrenia

Objective: Establishing a link between the structure and severity of psychopathological symptoms and the level of functioning in patients at risk of schizophrenia. Material and Methods: The study examined 38 patients with a depressive episode with attenuated positive symptoms (APS) from the risk group of schizophrenia hospitalized in 2011-2015. The follow-up was 7.3 ± 1.7 years. At the time of the examination, all patients were in remission. HDRS (Hamilton Depression Rating Scale), SOPS (Scale of Prodromal Symptoms) and (SANS) Scale for Assessment of Negative Symptoms were used. Statistical analysis was carried out using the Statistica 12 program. Results: At the time of the survey, 21.1% of the cases were diagnosed as schizophrenic (F25 and F20 according to ICD-10), 28.9 % as affective (F34.0, F31.3, F31.7 and F33.4), 13.2 % as personal disorders (F60.1, F60.a, F3.8 per cent) and 36,8 % as schizotypal disorders (F21.3, F21.4, F21.5, F21.8). Social performance on the PSP scale of 13.2 % was rated as high (100-81 points), 28.9 % and 31.6 % as average (80-61 and 60-41 points respectively) and 26.3 % as low (less than 40 points). The strongest correlations (p˂0.05) are found between total scores on the SOPS scale, negative SOPS scores, total SANS score and PSP score (- 0.854, - 0.876, - 0.812 respectively), subscale of negative SOPS symptoms and socially beneficial PSP activity (-0.831) subscale of apathy-anhedonia SANS and social relations PSP (0,801). Discussion: A high level of social functioning is possible provided there is a complete reduction of the prodromal and depressive symptoms, at medium levels, functioning is determined primarily by increasing negative symptoms, especially the domain of avolition - apathy, and low levels are formed by persistent APS, increasing symptoms of disorganization and negative symptoms. Conclusion: The study showed that the outcome of the first depressive episode with the risk symptoms of schizophrenia is generally characterized by some degree of decline in social functioning, which cannot be considered as a phenomenon in its own right, on the contrary, it’s a derivative of psychopathological symptoms.

Home alone: Social functioning as a transdiagnostic marker of mental health in youth, exploring retrospective and daily life measurements

PurposeEarly detection and intervention of mental health problems in youth are topical given that mental disorders often start early in life. Young people with emerging mental disorders however, often present with non-specific, fluctuating symptoms. Recent reports indicate a decline in social functioning (SF) as an early sign of specific emerging mental disorders such as depression or anxiety, making SF a favorable transdiagnostic approach for earlier detection and intervention. Our aim was to investigate the value of SF in relation to transdiagnostic symptoms, and as a predictor of psychopathology over time, while exploring traditional retrospective versus innovative daily diary measurements of SF in youth. MethodParticipants (N = 75) were 16–25 years of age and presented early stage psychiatric symptomatology. Psychiatric symptoms, including anxiety and depression, as well as SF -both in retrospect and in daily life- were assessed at two time points and analyzed cross-sectionally and longitudinally. ResultsA significant and negative association between SF and all psychiatric symptoms was found, and SF was a significant predictor of change in general psychiatric symptoms over time. Results were only significant when SF was measured traditionally retrospective. ConclusionThis study confirms a distinct relation between SF and transdiagnostic psychiatric symptoms in youth, even in a (sub)clinical population, and points towards SF as a predictor of transdiagnostic psychiatric symptoms. Further research is needed to learn more about the added value of daily life versus retrospective measurements.

N400 event-related brain potential and functional outcome in persons at clinical high risk for psychosis: A longitudinal study.

The N400 event-related brain potential (ERP) semantic priming effect is thought to reflect activation by meaningful stimuli of related concepts in semantic memory and has been found to be deficient in schizophrenia. We tested the hypothesis that, among individuals at clinical high risk (CHR) for psychosis, N400 semantic priming deficits predict worse symptomatic and functional outcomes after one year. We measured N400 semantic priming at baseline in CHR patients (n=47) and healthy control participants (n=25) who viewed prime words each followed by a related or unrelated target word, at stimulus-onset asynchronies (SOAs) of 300 or 750 ms. We measured patients' psychosis-like symptoms with the Scale of Prodromal Symptoms (SOPS) Positive subscale, and academic/occupational and social functioning with the Global Functioning (GF):Role and Social scales, respectively, at baseline and one-year follow-up (n=29). CHR patients exhibited less N400 semantic priming than controls across SOAs; planned contrasts indicated this difference was significant at the 750-ms but not the 300-ms SOA. In patients, reduced N400 semantic priming at the 750-ms SOA was associated with lower GF:Social scores at follow-up, and greater GF:Social decrements from baseline to follow-up. Patients' N400 semantic priming was not associated with SOPS Positive or GF:Role scores at follow-up, or change in these from baseline to follow-up. In CHR patients, reduced N400 semantic priming at baseline predicted worse social functioning after one year, and greater decline in social functioning over this period. Thus, the N400 may be a useful prognostic biomarker of real-world functional outcome in CHR patients.

Cognitive-Behavioral Social Skills Training for patients with late-life schizophrenia and the moderating effect of executive dysfunction

The objectives of this study are to test the efficacy of Cognitive-Behavioral Social Skills Training (CBSST) in enhancing social function in a sample of older patients with schizophrenia, and to assess whether baseline cognition moderates response to CBSST. To address these objectives, we conducted a randomized controlled trial of 63 participants, randomized 1:1 into CBSST or Treatment-As-Usual (TAU). The setting was a community-based geriatric mental health outpatient clinic in Toronto, Ontario, Canada. Data were collected at baseline, and week 18, 36 and 52, between June 2008 and May 2014. Participants were outpatients, aged 60 or older, with a diagnosis of schizophrenia or schizoaffective disorder and no evidence of dementia or other conditions associated with cognitive or functional impairment. The intervention was a weekly group CBSST for 36 weeks. Cognition, including executive function, was assessed at baseline. Modified total score on the Independent Living Skills Survey (ILSS) at 18, 36, and 52 weeks was the primary outcome measure. In a linear mixed model analysis, the ILSS trajectory was better in the CBSST group than the TAU group, with significantly better function at 36 (Cohen's d = 0.75) and 52 weeks (Cohen's d = 0.92). Baseline executive dysfunction moderated CBSST response, whereby participants with more severe executive dysfunction experienced the most improvement in ILSS. CBSST was efficacious in patients with late-life schizophrenia and prevented decline in social function over a one-year period. CBSST was most beneficial for patients with more severe executive dysfunction, i.e., those who needed skills training the most.

Association between oral, social, and physical frailty in community-dwelling older adults

ObjectivesOral frailty (OF) has been shown to be a predictor of disability. Therefore, it is important to be able to identify factors associated with OF in order to prevent long-term dependence. The purpose of this study was to clarify the relationships between OF, social frailty (SF), and physical frailty (PF) in community-dwelling older adults, with the overarching aim of informing the future development of effective measures to prevent frailty. MethodsOral, physical, and social function, nutritional and psychological status, and medical history were examined in 682 community-dwelling individuals (267 men, 415 women) aged ≥ 65 years. Ordinal logistic regression analysis with SF and PF as independent variables was performed with pass analysis to determine the relationship between the different types of frailty. ResultsLogistic regression analysis revealed significant associations between OF and decline in social function, physical function, and nutritional status, and an increase in the number of medications used. Path analysis showed that SF was directly related to OF and that OF and SF were directly related to PF. ConclusionsThese findings suggest that a decline in social function may directly influence a decline in oral and physical function. The results of this study provide initial evidence, that may guide the future development of measures that aim to prevent and manage OF.

SOCIAL ROLE RELATIONSHIP TO DEPRESSION IN THE ELDERLY IN CANDIMULYO VILLAGE JOMBANG SUBDISTRICT

Depression is one of the disorders in the nature of feelings (affective, mood) characterized by depression, sadness, lethargy, loss of passion, no spirit in the self. The elderly will be more susceptible to depression if in the elderly are less able to socialize with the surrounding environment against the decline in social function. The purpose of this study is to find out the relationship of social role to depression in the elderly in Candimulyo Village, Jombang Regency. Research design is correlation analytics. The population in this study is elderly in Candimulyo Village, Jombang Regency. In this study, the sampling technique used is Simple Random Sampling. Data collection using questionnaires by processing data using editing, cooding scoring, tabulating with spearman rank statistical tests. The results showed that 50 respondents were known that respondents who experienced bad social roles as many as 19 (38.0%), respondents who experienced moderate social roles as much as (30.0%), respondents who experienced good social roles as much as (2.0%). Respondents who experienced a level of major depression as much as (48.0 %), moderate depression level as much as (40%), severe depression level once (8.0%) and mild depression rate (4.0%). The conclusion of this study there is a relationship between the social role of depression in the elderly in Candimulyo Village, Jombang Regency.

Epidemiology of Cardiovascular Diseases in the Elderly.

This chapter focuses on the epidemiology of cardiovascular diseases in elderly adults who are 65 or older. Risk factors for morbidity and mortality, as well as variables associated with disability and physical and social functional decline in the elderly individuals are considered. Modifiable risk factors, such as life habits are differentiated from unmodifiable ones, such as age and sex. The chapter concentrates in particular on the impact of hypertension, dyslipidemia and diabetes on cardiovascular diseases and mortality, as well as the effect of cigarettes smoking, physical activity, obesity and isolation on cardiovascular diseases and quality of life. The results demonstrate that cardiovascular diseases are not necessarily a consequence of aging; instead, they are often linked to modifiable risk factors. We can conclude that specific, targeted prevention interventions should preferably be implemented when individuals are young, but they are also useful in the elderly not only to prolong life but also to improve their quality of life.

The Influence of Negative Symptoms on the Social Function of People with Schizophrenia in the Community

Abstract: The most People with Schizophrenia (PwS) experience a decline in social function caused by various factors. Clinical symptoms of PwS affect the social function of PwS, especially negative symptoms. The purpose of this study is to analyze the effect of negative symptoms on the social function of people with schizophrenia in the community. This is a cross-sectional study. Subjects of the study were people with schizophrenia aged 18-56 years who will follow Community-Based Rehabilitation activities in 10 areas of puskesmas in Yogyakarta Special Region. The study was conducted in February 2017. The social function and negative symptoms of PwS were measured using a validated measuring instrument. Hypothesis test using Anova test. The subjects of the study were obtained by purposive sampling technique of 100 PwS that fulfilled inclusion and exclusion criteria. Subjects with a PSP score of 0-30 (poor: someone who intensively needs care and social support) of 8 people (8%) had negative PANSS score of 28.50 ± 6.78. Subjects with a score of 31-70 (moderate: someone who occasionally needs care and social support) of 57 people (57%) had negative PANSS of 20.65 ± 8.18. Subjects with a score of 71-100 (mild: someone with mild disturbance, but able to perform individual functions) of 35 subjects (35%) had negative PANSS score of 12.49 ± 5.98. PwS which has a negative value of PANSS is greater, has a worse social function. The results showed that the negative symptoms had an effect on the social function of people with schizophrenia which was statistically significant (p <0.05). Negative symptoms affect the social function of PwS. PwS that has a high negative symptom score, has a worse social function. Keywords: social function, schizophrenia, negative symptoms

The relationship between depression and socioeconomic factors

Introduction: Depression is a commonly occurring worldwide disorder linked to a decline in social functioning and quality of life. Socioeconomic factors can influence the prevalence and course of depression, but the studies results are controversial because they vary across countries. Objectives: The purpose of this research was to study associations between socioeconomic indicators present at patients with depression and hospitalization outcomes. Methods: The study included a group of 410 patients, with ages between 18 and 65 years, diagnosed with depressive episode or recurrent depressive disorder that were hospitalized in the “Prof. Dr. Al. Obregia” Psychiatry Hospital of Bucharest, between June 1, 2016 and May 31, 2017. Results: The mean age of the group was 54.23 years, 80% of the lot were female patients, 41.76% had graduated vocational school or not graduated high school and 79.99% were retired. The number of readmissions had a mean value of 5.65 and the mean value for the hospitalization days was 9.00. We found statistical significant differences regarding the length of hospitalization for the different categories of education and employment status. Conclusions: Depression is a high prevalence, impairing disorder associated with the individuals socioeconomic status and this study results demonstrate the importance of future research in this domain.

Long-term outcomes of trauma-focused treatment in psychosis.

We present 12-month follow-up results for a randomised controlled trial of prolonged exposure and eye movement desensitisation and reprocessing (EMDR) therapy in 85 (78.8%) participants with psychotic disorder and comorbid post-traumatic stress disorder (PTSD). Positive effects on clinician-rated PTSD, self-rated PTSD, depression, paranoid-referential thinking and remission from schizophrenia were maintained up to 12-month follow-up. Negative post-traumatic cognitions declined in prolonged exposure and were stable in EMDR. A significant decline in social functioning was found, whereas reductions in interference of PTSD symptoms with social functioning were maintained. These results support that current PTSD guidelines apply to individuals with psychosis. Declaration of interest M.v.d.G. and D.v.d.B. receive income for published books on psychotic disorders and for the training of postdoctoral professionals in the treatment of psychotic disorders. A.d.J. receives income for published books on EMDR therapy and for the training of postdoctoral professionals in this method. A.v.M. receives income for published book chapters on PTSD and for the training of postdoctoral professionals in prolonged exposure. C.d.R. receives income for the training of postdoctoral professionals in EMDR therapy.

Psychogenic Nonepileptic Seizures in Women.

Psychogenic nonepileptic seizures (PNES) are the most common type of functional neurological symptom disorders and are frequently diagnosed in tertiary care epilepsy monitoring units. These are associated with significant decline in social functioning and quality of life. The majority of patients with PNES are women, outnumbering men by a ratio of 3:1. Female sex preponderance occurs after puberty and usually before the age of 55 years. Many of the psychiatric risk factors in PNES (depression, anxiety, history of traumatic experiences, other somatic symptom disorders) are more common in women and may partially account for the difference in sex prevalence. Neurobiological and neurohumoral mechanisms may also play a role, but our understanding is limited at this point. In this review, we present information on epidemiology and risk factors, neurobiological and psychological mechanisms, clinical approach to diagnosis, evidence-based treatment, and long-term outcomes. We highlight findings related to differences between women and men in PNES. Most of these data are not decisive and require further corroboration. While the disorder may be more frequently suspected in women, all patients with suspected PNES deserve an objective and thorough investigation of their symptoms. Early and accurate identification of this disorder should be a priority, especially as evidence-based treatments, which may lead to improved outcomes, are increasingly available.

Abnormal functional connectivity of the posterior cingulate cortex is associated with depressive symptoms in patients with Alzheimer's disease.

BackgroundDepressive symptoms are significant and very common psychiatric complications in patients with Alzheimer’s disease (AD), which can aggravate the decline in social function. However, changes in the functional connectivity (FC) of the brain in AD patients with depressive symptoms (D-AD) remain unclear.ObjectiveTo investigate whether any differences exist in the FC of the posterior cingulate cortex (PCC) between D-AD patients and non-depressed AD patients (nD-AD).Materials and methodsWe recruited 15 D-AD patients and 17 age-, sex-, educational level-, and Mini-Mental State Examination (MMSE)-matched nD-AD patients to undergo tests using the Neuropsychiatric Inventory, Hamilton Depression Rating Scale, and 3.0T resting-state functional magnetic resonance imaging. Bilateral PCC were selected as the regions of interest and between-group differences in the PCC FC network were assessed using Student’s t-test.ResultsCompared with the nD-AD group, D-AD patients showed increased PCC FC in the right amygdala, right parahippocampus, right superior temporal pole, right middle temporal lobe, right middle temporal pole, and right hippocampus (AlphaSim correction; P<0.05). In the nD-AD group, MMSE scores were positively correlated with PCC FC in the right superior temporal pole and right hippocampus (false discovery rate corrected; P<0.05).ConclusionDifferences were detected in PCC FC between nD-AD and D-AD patients, which may be related to depressive symptoms. Our study provides a significant enhancement to our understanding of the functional mechanisms underlying D-AD.

SF-DEM: a new instrument for assessing social functioning in dementia

BackgroundThere is no standardised instrument for assessing social functioning in dementia, even though decline in social functioning is one of the diagnostic criteria for dementia and important to patients and their families. We aimed to develop a valid, reliable, acceptable instrument for assessing social function in people with dementia. MethodsWe conducted qualitative interviews with 18 dyads of people with dementia and their family carers, a literature review, and focus groups with expert health-care professionals to develop the Social Functioning in Dementia (SF-DEM) instrument. SF-DEM measures the social functioning of a person with dementia using their own rating or a family carer's rating. We tested acceptability and psychometric properties of these measures in structured interviews at baseline and at 4 weeks' and 6–8 months' follow-up in a cohort of 30 dyads of people with mild dementia and their carers. FindingsSF-DEM had content validity. The instrument was acceptable to both patients and carers, who all rated it as acceptable or very acceptable. Inter-rater agreement was good or very good for all questions. Test–retest reliability was very strong for the carer-rated SF-DEM (intraclass correlation coefficient 0·89, 95% CI 0·73 to 0·96) and patient-rated version (0·80, 0·54 to 0·92), and both versions had internal consistency (Cronbach's α=0·71 for carer-rated SF-DEM and 0·64 for patient-rated). SF-DEM had concurrent validity, since it was moderately correlated with a question about overall social functioning (r=0·60, 95% CI 0·29 to 0·78 for carer-rated; 0·44, 0·07 to 0·68 for patient-rated). SF-DEM also had convergent validity, as evidenced by a moderate correlation between patient and carer ratings (r=0·59, 95% CI 0·07 to 0·81). At follow-up (mean duration 7·2 months, SD 0·5), patient-rated SF-DEM score increased by 1·3 points (95% CI −0·3 to 2·9, p=0·10) and caregiver-rated SF-DEM score increased by 1·4 points (−0·1 to 2·9, p=0·06) for each point on a five point ordinal scale of social change. InterpretationPatient-rated and carer-rated versions of the SF-DEM are reliable, valid, and acceptable measures of social function in people with mild dementia. Further research is required to test the generalisability to other populations. FundingNone.

The Role of Cognition and Social Functioning as Predictors in the Transition to Psychosis for Youth With Attenuated Psychotic Symptoms.

In the literature, there have been several attempts to develop prediction models for youth who are at clinical high risk (CHR) of developing psychosis. Although there are no specific clinical or demographic variables that seem to consistently predict the later transition to psychosis in those CHR youth, in addition to attenuated psychotic symptoms, the most commonly occuring predictors tend to be poor social functioning and certain cognitive tasks. Unfortunately, there has been little attempt to replicate alogorithms. A recently published article by Cornblatt et al suggested that, for individuals with attentuated psychotic symptoms (APS), disorganized communication, suspiciousness, verbal memory, and a decline in social functioning were the best predictors of later transition to psychosis (the RAP model). The purpose of this article was to first test the prediction model of Cornblatt et al with a new sample of individuals with APS from the PREDICT study. The RAP model was not the best fit for the PREDICT data. However, using other variables from PREDICT, it was demonstrated that unusual thought content, disorganized communication, baseline social functioning, verbal fluency, and memory, processing speed and age were predictors of later transition to psychosis in the PREDICT sample. Although the predictors were different in these 2 models, both supported that disorganized communication, poor social functioning, and verbal memory, were good candidates as predictors for later conversion to psychosis.

Gesture Performance in Schizophrenia Predicts Functional Outcome After 6 Months.

The functional outcome of schizophrenia is heterogeneous and markers of the course are missing. Functional outcome is associated with social cognition and negative symptoms. Gesture performance and nonverbal social perception are critically impaired in schizophrenia. Here, we tested whether gesture performance or nonverbal social perception could predict functional outcome and the ability to adequately perform relevant skills of everyday function (functional capacity) after 6 months. In a naturalistic longitudinal study, 28 patients with schizophrenia completed tests of nonverbal communication at baseline and follow-up. In addition, functional outcome, social and occupational functioning, as well as functional capacity at follow-up were assessed. Gesture performance and nonverbal social perception at baseline predicted negative symptoms, functional outcome, and functional capacity at 6-month follow-up. Gesture performance predicted functional outcome beyond the baseline measure of functioning. Patients with gesture deficits at baseline had stable negative symptoms and experienced a decline in social functioning. While in patients without gesture deficits, negative symptom severity decreased and social functioning remained stable. Thus, a simple test of hand gesture performance at baseline may indicate favorable outcomes in short-term follow-up. The results further support the importance of nonverbal communication skills in subjects with schizophrenia.

Personalized Prediction of Psychosis: External Validation of the NAPLS-2 Psychosis Risk Calculator With the EDIPPP Project.

As part of the second phase of the North American Prodrome Longitudinal Study (NAPLS-2), Cannon and colleagues report, concurrently with the present article, on a risk calculator for the individualized prediction of a psychotic disorder in a 2-year period. The present study represents an external validation of the NAPLS-2 psychosis risk calculator using an independent sample of patients at clinical high risk for psychosis collected as part of the Early Detection, Intervention, and Prevention of Psychosis Program (EDIPPP). Of the total EDIPPP sample of 210 subjects rated as being at clinical high risk based on the Structured Interview for Prodromal Syndromes, 176 had at least one follow-up assessment and were included in the construction of a new prediction model with six predictor variables in the NAPLS-2 psychosis risk calculator (unusual thoughts and suspiciousness, symbol coding test performance, verbal learning test performance, decline in social functioning, baseline age, and family history). Discrimination performance was assessed with the area under the receiver operating characteristic curve (AUC). The NAPLS-2 risk calculator was then used to generate a psychosis risk estimate for each case in the external validation sample. The external validation model showed good discrimination, with an AUC of 0.790 (95% CI=0.644-0.937). In addition, the personalized risk generated by the risk calculator provided a solid estimation of the actual conversion outcome in the validation sample. Two independent samples of clinical high-risk patients converge to validate the NAPLS-2 psychosis risk calculator. This prediction calculator represents a meaningful step toward early intervention and the personalized treatment of psychotic disorders.

An Individualized Risk Calculator for Research in Prodromal Psychosis.

Approximately 20%-35% of individuals 12-35 years old who meet criteria for a prodromal risk syndrome convert to psychosis within 2 years. However, this estimate ignores the fact that clinical high-risk cases vary considerably in risk. The authors sought to create a risk calculator, based on profiles of risk indicators, that can ascertain the probability of conversion to psychosis in individual patients. The study subjects were 596 clinical high-risk participants from the second phase of the North American Prodrome Longitudinal Study who were followed up to the time of conversion to psychosis or last contact (up to 2 years). The predictors examined were limited to those that are supported by previous studies and are readily obtainable in general clinical settings. Time-to-event regression was used to build a multivariate model predicting conversion, with internal validation using 1,000 bootstrap resamples. The 2-year probability of conversion to psychosis was 16%. Higher levels of unusual thought content and suspiciousness, greater decline in social functioning, lower verbal learning and memory performance, slower speed of processing, and younger age at baseline each contributed to individual risk for psychosis. Stressful life events, trauma, and family history of schizophrenia were not significant predictors. The multivariate model achieved a concordance index of 0.71 and, as reported in an article by Carrión et al., published concurrently with this one, was validated in an independent external data set. The results are instantiated in a web-based risk prediction tool envisioned to be most useful in research protocols involving the psychosis prodrome. A risk calculator comparable in accuracy to those for cardiovascular disease and cancer is available to predict individualized conversion risks in newly ascertained clinical high-risk cases. Given that the risk calculator can be validly applied only for patients who screen positive on the Structured Clinical Interview for Psychosis Risk Syndromes, which requires training to administer, its most immediate uses will be in research on psychosis risk factors and in research-driven clinical (prevention) trials.

Development of a stage-dependent prognostic model to predict psychosis in ultra-high-risk patients seeking treatment for co-morbid psychiatric disorders.

Current ultra-high-risk (UHR) criteria appear insufficient to predict imminent onset of first-episode psychosis, as a meta-analysis showed that about 20% of patients have a psychotic outcome after 2 years. Therefore, we aimed to develop a stage-dependent predictive model in UHR individuals who were seeking help for co-morbid disorders. Baseline data on symptomatology, and environmental and psychological factors of 185 UHR patients (aged 14-35 years) participating in the Dutch Early Detection and Intervention Evaluation study were analysed with Cox proportional hazard analyses. At 18 months, the overall transition rate was 17.3%. The final predictor model included five variables: observed blunted affect [hazard ratio (HR) 3.39, 95% confidence interval (CI) 1.56-7.35, p < 0.001], subjective complaints of impaired motor function (HR 5.88, 95% CI 1.21-6.10, p = 0.02), beliefs about social marginalization (HR 2.76, 95% CI 1.14-6.72, p = 0.03), decline in social functioning (HR 1.10, 95% CI 1.01-1.17, p = 0.03), and distress associated with suspiciousness (HR 1.02, 95% CI 1.00-1.03, p = 0.01). The positive predictive value of the model was 80.0%. The resulting prognostic index stratified the general risk into three risk classes with significantly different survival curves. In the highest risk class, transition to psychosis emerged on average ⩾8 months earlier than in the lowest risk class. Predicting a first-episode psychosis in help-seeking UHR patients was improved using a stage-dependent prognostic model including negative psychotic symptoms (observed flattened affect, subjective impaired motor functioning), impaired social functioning and distress associated with suspiciousness. Treatment intensity may be stratified and personalized using the risk stratification.