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

Published online by Cambridge University Press:  15 April 2020

R.K.R. Salokangas ,
M. Heinimaa ,
T. From ,
E. Löyttyniemi ,
T. Ilonen ,
S. Luutonen ,
J. Hietala ,
T. Svirskis ,
H.G. von Reventlow  and
G. Juckel
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R.K.R. Salokangas*
Affiliation:
Department of Psychiatry, University of Turku 70, Kunnallissairaalantie, 20700Turku, Finland Psychiatric Clinic, Turku University Central Hospital, Turku, Finland Turku Psychiatric Clinic, Turku Mental Health Centre, Turku, Finland
M. Heinimaa
Affiliation:
Department of Psychiatry, University of Turku 70, Kunnallissairaalantie, 20700Turku, Finland
T. From
Affiliation:
Department of Psychiatry, University of Turku 70, Kunnallissairaalantie, 20700Turku, Finland
E. Löyttyniemi
Affiliation:
Department of Biostatistics, University of Turku, Turku, Finland
T. Ilonen
Affiliation:
Department of Psychiatry, University of Turku 70, Kunnallissairaalantie, 20700Turku, Finland
S. Luutonen
Affiliation:
Department of Psychiatry, University of Turku 70, Kunnallissairaalantie, 20700Turku, Finland Psychiatric Clinic, Turku University Central Hospital, Turku, Finland
J. Hietala
Affiliation:
Department of Psychiatry, University of Turku 70, Kunnallissairaalantie, 20700Turku, Finland Psychiatric Clinic, Turku University Central Hospital, Turku, Finland Turku Psychiatric Clinic, Turku Mental Health Centre, Turku, Finland
T. Svirskis
Affiliation:
Department of Psychiatry, University of Helsinki, Helsinki, Finland Peijas Hospital, Helsinki University Central Hospital, Helsinki, Finland
H.G. von Reventlow
Affiliation:
Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, Bochum, Germany
G. Juckel
Affiliation:
Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, Bochum, Germany
D. Linszen
Affiliation:
Department of Psychiatry and Psychology, University of Maastricht, Maastricht, Netherlands
P. Dingemans
Affiliation:
Mediant, Enschede, Netherlands
M. Birchwood
Affiliation:
School of Psychology, University of Birmingham, Birmingham, United Kingdom
P. Patterson
Affiliation:
Youthspace – Birmingham & Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
F. Schultze-Lutter
Affiliation:
University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
S. Ruhrmann
Affiliation:
Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
J. Klosterkötter
Affiliation:
Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
*
*Corresponding author. E-mail address:raimo.k.r.salokangas@utu.fi (R.K.R. Salokangas).
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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

Premorbid adjustmentClinical high riskFunctional outcome
Type
Original article
Information
European Psychiatry , Volume 29 , Issue 6 , August 2014 , pp. 371 - 380
Copyright
Copyright © Elsevier Masson SAS 2014

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