Elsevier

Journal of Psychiatric Research

Volume 81, October 2016, Pages 95-101
Journal of Psychiatric Research

Duration of attenuated positive and negative symptoms in individuals at clinical high risk: Associations with risk of conversion to psychosis and functional outcome

https://doi.org/10.1016/j.jpsychires.2016.06.021Get rights and content

Abstract

Research in individuals at clinical high-risk (CHR) for psychosis has focused on subjects with no more than 12 months of present or worsened attenuated positive symptoms. However, the impact of long duration attenuated positive and/or negative prodromal symptoms on outcomes is unclear. Seventy-six CHR subjects with attenuated positive symptoms and at least moderate severity level negative symptoms rated on the Scale of Prodromal Symptoms (SOPS) were prospectively followed for a mean of 3.0 ± 1.6 years. Social and Role functioning was assessed with the Global Functioning: Social and Role scales. Correlations between attenuated positive and negative symptom duration and severity and conversion to psychosis and functional outcomes were analyzed. The average onset of SOPS rated negative symptoms (M = 53.24 months, SD = 48.90, median = 37.27) was approximately twelve months prior to the emergence of attenuated positive symptom (M = 40.15 months, SD = 40.33, median = 24.77, P < 0.05). More severe positive symptoms (P = 0.004), but not longer duration of positive (P = 0.412) or negative (P = 0.754) symptoms, predicted conversion to psychosis. Neither positive symptom duration (P = 0.181) nor severity (P = 0.469) predicted role or social functioning at study endpoint. Conversely, longer negative symptom duration predicted poor social functioning (P = 0.004). Overall, our findings suggest that the severity of attenuated positive symptoms at baseline may be more important than symptom duration for determining individuals at increased risk of developing psychosis. In contrast, long-standing negative symptoms may be associated with persistent social difficulties and therefore have an important position in the treatment of disability.

Section snippets

Participants

The Recognition and Prevention (RAP) program is an ongoing longitudinal study of treatment-seeking adolescents and young adults considered to be at CHR for psychosis initiated in 1998 and funded by the National Institute of Mental Health in 2000. This article reports data for participants recruited during Phase 1 (2000–2006) of the study. Patient referrals were made to the RAP Program by affiliated outpatient and inpatient psychiatry departments, local mental health providers, school

Results

CHR+ subjects had a mean age of 16.0 ± 2.2 years and were mostly male (68.4%) and white (78.9%) (see Table 1). In terms of symptoms, suspiciousness was the most prevalent positive symptom (68.4%) rated at a moderate intensity or above (≥3 on the SOPS) at baseline, while grandiosity (6.6%) was the lowest reported symptom. Within the negative symptom dimension, Decline in Occupational/Academic Functioning (77.6%), Social Anhedonia (59.2%), and Avolition (46.1%) were most prevalent at baseline

Discussion

To the best of our knowledge, this is the first study to report on the pre-baseline duration of attenuated positive symptoms and negative symptoms in CHR individuals and their relationships with symptom severity and outcome. The current study did not artificially and arbitrarily restrict the duration of onset or worsening of attenuated positive symptoms to the past 12 months prior to baseline, allowing us to compare the duration of attenuated positive and negative symptoms and to examine if, in

Conflicts of interest

Drs. Carrión, Auther, Lencz, and Ms. McLaughlin, Olsen, and Demmin report no financial relationships with commercial interests. Dr. Cornblatt has been an advisor for Hoffmann-La Roche.

Dr. Correll has been a consultant and/or advisor to or has received honoraria from AbbVie, Acadia, Actavis, Alkermes, Eli Lilly, Genentech, Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, Lundbeck, MedAvante, Medscape, Otsuka, Pfizer, ProPhase, Reviva, Roche, Sunovion, Supernus, and Takeda. He has

Contributors

BC developed and oversaw the research protocol. RO and AA contributed to participant recruitment. AA, DM, and TL conducted clinical assessments. CC oversaw treatment decisions. DD collected data. RC and DD performed the literature review. RC and DD performed statistical analysis. All authors contributed to and approved the final manuscript.

Funding

Supported by grants from the National Institute of Mental Health (NIMH): MH61523 (Dr. Cornblatt), the Zucker Hillside Hospital Advanced Center for Intervention and Services Research for the Study of Schizophrenia MH 074543 (John M Kane, M.D.). No funding source exerted any editorial direction or censorship on any part of this manuscript.

Acknowledgments

We thank the study participants and entire staff of the RAP Program for their time and effort from the very onset of these studies.

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      The CHR syndrome describes individuals who do not meet criteria for a DSM-5 psychotic disorder, but who experience attenuated psychotic symptoms, brief intermittent psychotic symptoms (BIPS), or genetic risk and recent declines in functioning (Addington et al., 2015; Cannon et al., 2008; Haroun et al., 2006). Deficits have been observed in CHR samples in social cognition, social communication, and overall social functioning (Carrión et al., 2016; Cotter et al., 2017; Glenthøj et al., 2016; Glenthøj et al., 2020; Osborne et al., 2019). Genetic risk for psychosis relates to poorer theory of mind (Gibson et al., 2010; Lee et al., 2015) and broad social cognitive impairments also appear to predict conversion to psychosis in CHR samples (Bora et al., 2008; Healey et al., 2013).

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