title: Cognitive impairments in individuals at clinical high-risk for psychosis: relationships to clinical symptoms and functioning and prediction of functional outcome
Creators: name: Haining, Kate
Publisher: name: University of Glasgow
Year: 2019
Subjects: subject: psychosis, clinical high risk, ultra-high risk, functional outcome, neurocognition, social cognition, prediction, early interventions.

description: Introduction: Traditionally, research in the clinical-high risk (CHR) for psychosis population has focused on a dichotomous measure of transition to psychosis. In light of declining transition rates, it is becoming increasingly important to focus on continuous measures of outcome such as functional status. Moreover, studies have almost exclusively utilised clinically presenting/help-seeking samples, limiting the generalisability of findings. Utilising a sample of CHR participants primarily recruited from the general population, this study aimed to investigate the relationship between cognitive performance, clinical symptoms and functioning at baseline; and baseline predictors of functional outcome at 6- and 12-months follow-up. Methods: Data was available for 129 CHR individuals at baseline, 86 CHR individuals at 6-month follow-up and 69 CHR individuals at 12-month follow-up. 46 CHR-negative (CHR-N) participants (n = 40 at follow-up) who did not meet CHR criteria and 55 healthy controls (HCs) were also included. All participants were assessed on clinical, functional and cognitive variables at baseline. Functional outcome was assessed using the global assessment of functioning (GAF) score at follow-up. Results: Emotion recognition response time (RT), either alone or in combination with other cognitive variables, was associated with clinical symptoms and functioning at baseline. Over half of CHR individuals were classified as having a poor functional outcome (PFO) at 6- and 12-months with functioning remaining relatively stable over time. PFO at 6-month follow-up was predicted by impairments in attention and processing speed, working memory, global functioning and role functioning at baseline. PFO at 12-month follow-up was predicted by reduced attention accuracy and poor global functioning at baseline. The areas under the curve for the 6- and 12-month prediction models were 0.911 and 0.818, respectively, demonstrating high discriminative abilities. Discussion: These findings emphasise the importance of focusing on a broader outcome of interest in individuals at CHR for psychosis, rather than the arbitrary threshold of psychosis transition. At baseline, neurocognitive and social cognitive performance were predictive of clinical symptoms and functioning whilst reduced neurocognitive performance and functional impairments at baseline predicted PFO at follow-up. These findings highlight the importance of such predictive factors for detecting false positives as well as the potential benefits of interventions incorporating vocational and educational rehabilitation and cognitive remediation. Furthermore, given that the majority of the CHR sample were recruited from the general population, clinical early detection teams should extend their services into the community in order to improve access to such interventions.