Grazia Rutigliano1, Lucia Valmaggia2, Paola Landi1, Marianna Frascarelli3, Marco Cappucciati4, Victoria Sear5, Matteo Rocchetti4, Andrea De Micheli4, Ceri Jones6, Erika Palombini4, Philip McGuire2, Paolo Fusar-Poli7. 1. King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 2. King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom. 3. King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy. 4. King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. 5. OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom. 6. King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom. 7. King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom. Electronic address: paolo.fusar-poli@kcl.ac.uk.
Abstract
BACKGROUND: Patients at ultra-high risk for psychosis (UHR) are a highly heterogeneous group in terms of clinical and functional outcomes. Several non-psychotic mental disorders co-occur together with the UHR state. Little is known about the impact of non-psychotic comorbid mental disorders on clinical and functional outcomes of UHR patients. METHODS: The sample included 154 UHR help-seeking patients (identified with the CAARMS, comprehensive assessment of the at-risk mental state), evaluated at baseline on the Ham-D, Ham-A (Hamilton depression/anxiety rating scale), and PANSS (positive and negative syndrome scale). 74 patients completed the 6-year follow-up assessment (mean=6.19, SD=1.87). Comorbid disorders at follow-up were assessed with the SCID I and II. Global functioning was rated on the global assessment of functioning (GAF) scale. RESULTS: In the present sample, 6-year risk of psychosis transition was 28.4%. Among non-transitioned UHR patients, 28.3% reported attenuated psychotic symptoms (APS) and 45.3% remained functionally impaired at follow-up (GAF<60). 56.8% patients were affected by at least one comorbid disorder at follow-up. Among UHR patients who presented with some comorbid disorder at baseline, 61.5% had persistent or recurrent course. Incident comorbid disorders emerged in 45.4% of baseline UHR patients. The persistence or recurrence of non-psychotic comorbid mental disorders was associated with poorer global functional outcomes at follow-up. LIMITATIONS: A substantial proportion of the initial sample was not available for follow-up interviews and some groups in the analyses had small sample size. Predictors of longitudinal outcomes were not explored. CONCLUSIONS: Among UHR patients, persistence or recurrence of non-psychotic comorbid mental disorders, mostly affective disorders, is associated with 6-year poor functional outcomes.
BACKGROUND:Patients at ultra-high risk for psychosis (UHR) are a highly heterogeneous group in terms of clinical and functional outcomes. Several non-psychotic mental disorders co-occur together with the UHR state. Little is known about the impact of non-psychotic comorbid mental disorders on clinical and functional outcomes of UHR patients. METHODS: The sample included 154 UHR help-seeking patients (identified with the CAARMS, comprehensive assessment of the at-risk mental state), evaluated at baseline on the Ham-D, Ham-A (Hamilton depression/anxiety rating scale), and PANSS (positive and negative syndrome scale). 74 patients completed the 6-year follow-up assessment (mean=6.19, SD=1.87). Comorbid disorders at follow-up were assessed with the SCID I and II. Global functioning was rated on the global assessment of functioning (GAF) scale. RESULTS: In the present sample, 6-year risk of psychosis transition was 28.4%. Among non-transitioned UHR patients, 28.3% reported attenuated psychotic symptoms (APS) and 45.3% remained functionally impaired at follow-up (GAF<60). 56.8% patients were affected by at least one comorbid disorder at follow-up. Among UHR patients who presented with some comorbid disorder at baseline, 61.5% had persistent or recurrent course. Incident comorbid disorders emerged in 45.4% of baseline UHR patients. The persistence or recurrence of non-psychotic comorbid mental disorders was associated with poorer global functional outcomes at follow-up. LIMITATIONS: A substantial proportion of the initial sample was not available for follow-up interviews and some groups in the analyses had small sample size. Predictors of longitudinal outcomes were not explored. CONCLUSIONS: Among UHR patients, persistence or recurrence of non-psychotic comorbid mental disorders, mostly affective disorders, is associated with 6-year poor functional outcomes.
Authors: Alice Masillo; M Brandizzi; L R Valmaggia; R Saba; N Lo Cascio; J F Lindau; L Telesforo; P Venturini; D Montanaro; D Di Pietro; M D'Alema; P Girardi; P Fiori Nastro Journal: Eur Child Adolesc Psychiatry Date: 2017-09-16 Impact factor: 4.785
Authors: Scott W Woods; Albert R Powers; Jerome H Taylor; Charlie A Davidson; Jason K Johannesen; Jean Addington; Diana O Perkins; Carrie E Bearden; Kristin S Cadenhead; Tyrone D Cannon; Barbara A Cornblatt; Larry J Seidman; Ming T Tsuang; Elaine F Walker; Thomas H McGlashan Journal: Schizophr Bull Date: 2018-02-15 Impact factor: 9.306
Authors: Jean Addington; Danijela Piskulic; Lu Liu; Jonathan Lockwood; Kristin S Cadenhead; Tyrone D Cannon; Barbara A Cornblatt; Thomas H McGlashan; Diana O Perkins; Larry J Seidman; Ming T Tsuang; Elaine F Walker; Carrie E Bearden; Daniel H Mathalon; Scott W Woods Journal: Schizophr Res Date: 2017-03-31 Impact factor: 4.939
Authors: Paolo Fusar-Poli; Andrea De Micheli; Rashmi Patel; Lorenzo Signorini; Syed Miah; Thomas Spencer; Philip McGuire Journal: Schizophr Bull Date: 2020-04-18 Impact factor: 9.306