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Decline in social functioning occurs in individuals who later develop psychosis.
To investigate whether baseline differences in disability are present in those who do and those who do not make a transition to psychosis in a group clinically at high risk and whether disability is a risk factor for transition.
Prospective multicentre, naturalistic field study with an 18-month follow-up period on 245 help-seeking individuals clinically at high risk. Disability was assessed with the Disability Assessment Schedule of the World Health Organization (WHODAS–II).
At baseline, the transition group displayed significantly greater difficulties in making new friends (z =−3.40, P = 0.001), maintaining a friendship (z =−3.00, P = 0.003), dealing with people they do not know (z =−2.28, P = 0.023) and joining community activities (z =−2.0, P = 0.05) compared with the non-transition group. In Cox regression, difficulties in getting along with people significantly contributed to the prediction of transition to psychosis in our sample (β = 0.569, s.e. = 0.184, Wald = 9.548, P = 0.002, hazard ratio (HR) = 1.767, 95% CI 1.238–2.550).
Certain domains of social disability might contribute to the prediction of psychosis in a sample clinically at high risk.
Risk of psychosis is defined by the presence of positive psychotic-like symptoms, by subtle self-perceived cognitive and perceptual deficiencies, or by decreased functioning with familial risk of psychosis. We studied the associations of psychiatric outpatients' self-reported functioning and interpersonal relationships with vulnerability to and risk of psychosis.
A total of 790 young patients attending psychiatric outpatient care completed the PROD screen [Heinimaa M, Salokangas RKR, Ristkari T, Plathin M, Huttunen J, Ilonen T, et al. PROD-screen – a screen for prodromal symptoms of psychosis. Int J Meth Psychiatr Res 2003;12:92–04.], including questions on functioning, interpersonal relationships and subtle specific (psychotic-like) and non-specific symptoms. Vulnerability to psychosis was assessed employing the patient's written descriptions of specific symptoms. Of the patients vulnerable to psychosis, those at current risk of psychosis were assessed using the Bonn Scale for Assessment of Basic Symptoms [Schultze-Lutter F, Klosterkötter J. Bonn scale for assessment of basic symptoms – prediction list, BSABS-P. Cologne: University of Cologne; 2002] and the Structured Interview for Positive symptoms [Miller TJ, McGlashan TH, Rosen JL, Somjee L, Markovich PJ, Stein K, et al. Prospective diagnosis of the initial prodrome for schizophrenia based on the structured interview for prodromal syndromes: preliminary evidence of interrater reliability and predictive validity. Am J Psychiatry 2002;159:863–65.].
In all, 219 patients vulnerable to and 55 patients at current risk of psychosis were identified. Vulnerability to psychosis was associated with all items of functioning and interpersonal relationships. Current risk of psychosis, however, was associated only with the subjectively reported negative attitude of others. Negative attitude of others was also associated with feelings of reference at both vulnerability and risk levels.
The subjective experience of negative attitude of others towards oneself may be an early indicator of psychotic development.
Depression is a frequent condition in early psychosis. Therefore, early
detection instruments should distinguish depression from beginning
To examine whether basic symptoms, i.e. subtle subjective deficits,
differ between participants suffering from a potential prodrome
(n = 146), first-episode schizophrenia
(n= 153) and non-psychotic depression
(n = 115)
Basic symptoms were assessed with the Schizophrenia Proneness
The prodrome and schizophrenia groups did not differ in level of basic
symptoms but both had higher levels than the depression group. DSM – IV
depression was frequent in those suffering from a potential prodrome
(38%) and first-episode schizophrenia (21%). In both groups, participants
with and without depression did not differ in basic symptoms. In
multivariate analyses, consideration of current depression generally
facilitated correct group classification, except for participants
suffering from both a potential prodrome and depression
Cognitive basic symptoms distinguished well between all three groups.
However, identification of persons suffering from a potential prodrome
might be enhanced by considering current affective status
Cognitive disturbances have been demonstrated in individuals with
potentially prodromal symptoms in objective–neuropsychological as well as
subjective-symptomatic studies. Yet, the relation between subjective and
objective deficits and to different prodromal states is unclear
To explore interactions between subjective and objective cognitive
measures in different prodromal states
In participants with an early (n=33) or late
(n=69) initial prodromal state, cognitive subjective
and objective deficits were assessed with the Schizophrenia Proneness
Instrument and a comprehensive neuropsychological test battery
Participants with an early initial prodromal state were less impaired
than those with a late initial state. Subjective and objective cognitive
deficits were unrelated, excepttime-limited neurocognitive speed measures
and subjectively reduced stress tolerance, especially in participants
with an early initial prodromal state
Subjective and objective cognitive deficits are generally unrelated in
the psychosis prodrome and as such they can add complementary information
valuable for prediction. However, possible associations between the two
levels might be better detectable in the less impaired early initial
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