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

Salokangas, R. K. R.; Heinimaa, M.; From, T.; Löyttyniemi, E.; Ilonen, T.; Luutonen, S.; Hietala, J.; Svirskis, T.; von Reventlow, H. G.; Juckel, G.; Linszen, D.; Dingemans, P.; Birchwood, M.; Patterson, P.; Schultze-Lutter, Frauke; Ruhrmann, S.; Klosterkötter, J. (2014). Short-term functional outcome and premorbid adjustment in clinical high-risk patients. Results of the EPOS project. European psychiatry, 29(6), pp. 371-380. Elsevier Masson SAS 10.1016/j.eurpsy.2013.10.003

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > University Psychiatric Services > University Hospital of Child and Adolescent Psychiatry and Psychotherapy
04 Faculty of Medicine > University Psychiatric Services > University Hospital of Child and Adolescent Psychiatry and Psychotherapy > Research Division

UniBE Contributor:

Schultze-Lutter, Frauke

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0924-9338

Publisher:

Elsevier Masson SAS

Language:

English

Submitter:

Nicole Jansen

Date Deposited:

13 Jun 2014 17:05

Last Modified:

11 Nov 2015 11:39

Publisher DOI:

10.1016/j.eurpsy.2013.10.003

PubMed ID:

24315804

Uncontrolled Keywords:

Clinical high risk, Functional outcome, Premorbid adjustment

BORIS DOI:

10.7892/boris.50635

URI:

https://boris.unibe.ch/id/eprint/50635

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