Duration of attenuated positive and negative symptoms in individuals at clinical high risk: Associations with risk of conversion to psychosis and functional outcome
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.
References (54)
- et al.
Duration of untreated psychosis and negative symptoms–a systematic review and meta-analysis of individual patient data
Schizophrenia Res.
(2012) - et al.
Does considering duration of negative symptoms increase their specificity for schizophrenia?
Schizophrenia Res.
(2003) - et al.
Duration of untreated negative and positive symptoms of psychosis and cognitive impairment in first episode psychosis
Schizophr. Res.
(2012) - et al.
Determinants of everyday outcomes in schizophrenia: the influences of cognitive impairment, functional capacity, and symptoms
Schizophr. Res.
(2009) - et al.
Nonspecific and attenuated negative symptoms in patients at clinical high-risk for schizophrenia
Schizophrenia Res.
(2004) Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course?
Biol. Psychiatry
(1999)- et al.
Negative symptom measurement in individuals at-risk for psychosis
Psychiatry Res.
(2013) - et al.
Negative symptoms in individuals at clinical high risk of psychosis
Psychiatry Res.
(2012) - et al.
Determinants of different aspects of everyday outcome in schizophrenia: the roles of negative symptoms, cognition, and functional capacity
Schizophr. Res.
(2015) - et al.
Baseline differences in clinical symptomatology between ultra high risk subjects with and without a transition to psychosis
Schizophr. Res.
(2009)
Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group
Schizophrenia Res.
Negative symptoms in schizophrenia. Definition and reliability
Archives General Psychiatry
Persistent negative symptoms in schizophrenia: an overview
Schizophr. Bull.
Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America
Arch. Gen. Psychiatry
Impact of neurocognition on social and role functioning in individuals at clinical high risk for psychosis
Am. J. Psychiatry
Prediction of functional outcome in individuals at clinical high risk for psychosis
JAMA Psychiatry
Gender difference in the prodromal symptoms of first-episode schizophrenia
J. Korean Med. Sci.
What factors are related to delayed treatment in individuals at high risk for psychosis?
Early Interv. Psychiatry
Catamnestic long-term study on the course of life and aging of schizophrenics
Schizophr. Bull.
Preliminary findings for two new measures of social and role functioning in the prodromal phase of schizophrenia
Schizophr. Bull.
Risk factors for psychosis: impaired social and role functioning
Schizophr. Bull.
Psychosis prevention: a modified strategy for selecting individuals at clinical high-risk for psychosis
Am. J. Psychiatry
The schizophrenia prodrome revisited: a neurodevelopmental perspective
Schizophr. Bull.
Research in people with psychosis risk syndrome: a review of the current evidence and future directions
J. Child. Psychol. Psychiatry
The psychosis high-risk state: a comprehensive state-of-the-art review
JAMA Psychiatry
Duration of untreated prodromal symptoms and 12-month functional outcome of individuals at risk of psychosis
Br. J. Psychiatry
Premorbid and onset features of first-episode schizophrenia
Schizophr. Bull.
Cited by (68)
Early risk factors in early-onset psychosis
2023, Adolescent Psychosis: Clinical and Scientific PerspectivesReciprocal Social Behavior and Related Social Outcomes in Individuals at Clinical High Risk for Psychosis
2021, Psychiatry ResearchCitation Excerpt :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).