Short-term functional outcome and premorbid adjustment in clinical high-risk patients. Results of the EPOS project

R K R Salokangas; M Heinimaa; T From; E Löyttyniemi; T Ilonen; S Luutonen; J Hietala; T Svirskis; H G von Reventlow; G Juckel; D Linszen; P Dingemans; M Birchwood; P Patterson; F Schultze-Lutter; S Ruhrmann; J Klosterkötter; EPOS group

doi:10.1016/j.eurpsy.2013.10.003

Short-term functional outcome and premorbid adjustment in clinical high-risk patients. Results of the EPOS project

Eur Psychiatry. 2014 Aug;29(6):371-80. doi: 10.1016/j.eurpsy.2013.10.003. Epub 2013 Dec 7.

Authors

R K R Salokangas¹, M Heinimaa², T From², E Löyttyniemi³, T Ilonen², S Luutonen⁴, J Hietala⁵, T Svirskis⁶, H G von Reventlow⁷, G Juckel⁷, D Linszen⁸, P Dingemans⁹, M Birchwood¹⁰, P Patterson¹¹, F Schultze-Lutter¹², S Ruhrmann¹³, J Klosterkötter¹³; EPOS group

Affiliations

¹ Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland; Psychiatric Clinic, Turku University Central Hospital, Turku, Finland; Turku Psychiatric Clinic, Turku Mental Health Centre, Turku, Finland. Electronic address: raimo.k.r.salokangas@utu.fi.
² Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland.
³ Department of Biostatistics, University of Turku, Turku, Finland.
⁴ Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland; Psychiatric Clinic, Turku University Central Hospital, Turku, Finland.
⁵ Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland; Psychiatric Clinic, Turku University Central Hospital, Turku, Finland; Turku Psychiatric Clinic, Turku Mental Health Centre, Turku, Finland.
⁶ Department of Psychiatry, University of Helsinki, Helsinki, Finland; Peijas Hospital, Helsinki University Central Hospital, Helsinki, Finland.
⁷ Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, Bochum, Germany.
⁸ Department of Psychiatry and Psychology, University of Maastricht, Maastricht, Netherlands.
⁹ Mediant, Enschede, Netherlands.
¹⁰ School of Psychology, University of Birmingham, Birmingham, United Kingdom.
¹¹ Youthspace - Birmingham & Solihull Mental Health Foundation Trust, Birmingham, United Kingdom.
¹² University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland.
¹³ Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.

PMID: 24315804
DOI: 10.1016/j.eurpsy.2013.10.003

Abstract

Purpose: In patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their childhood to adolescence premorbid adjustment.

Methods: In all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganised, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9-month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analysed.

Results: During the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 74% to 37%. Poor premorbid adjustment, single marital status, poor work status, and symptoms were associated with low baseline GAF scores. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model.

Conclusion: A great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are carried out.

Keywords: Clinical high risk; Functional outcome; Premorbid adjustment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adaptation, Psychological
Adolescent
Adult
Female
Humans
Male
Prodromal Symptoms*
Prognosis
Psychotic Disorders / diagnosis
Psychotic Disorders / psychology*
Risk
Schizophrenia / diagnosis
Schizophrenic Psychology*
Social Adjustment*
Young Adult

Grants and funding

WMCLAHRC-2014-1/DH_/Department of Health/United Kingdom