Premorbid functional development and conversion to psychosis in clinical high-risk youths

• Type of Material: Article
• Authors: Sarah I. Tarbox, Yale University; Jean Addington, University of Calgary; Kristin S. Cadenhead, University of California, San Diego; Tyrone D. Cannon, University of California, Los Angeles; Barbara A. Cornblatt, Zucker Hillside Hospital; Diana O. Perkins, University of North Carolina at Chapel Hill; Larry J. Seidman, Harvard University; Ming T. Tsuang, University of California, San Diego; Elaine Walker, Emory University; Robert Heinssen, National Institute of Mental Health; Thomas H. McGlashan, Yale University; Scott W. Woods, Yale University
• Language: English
• Date: 2013-11-01
• Publisher: Cambridge University Press (CUP): STM Journals
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Cambridge University Press 2013.
• Final Published Version (URL): http://dx.doi.org/10.1017/S0954579413000448
• Title of Journal or Parent Work: Development and Psychopathology
• ISSN: 0954-5794
• Volume: 25
• Issue: 4 PART 1
• Start Page: 1171
• End Page: 1186
• Grant/Funding Information: This work was supported by National Institute of Mental Health (U01 MH066134 to J.A.; R01 MH060720 and K24 MH76191 to K.S.C.; R01 MH065079 to T.D.C.; R01 MH061523 to B.A.C.; U01 MH066069 and P50 MH064065 to D.O.P; R01 MH065562 and P50 MH080272 to L.J.S.; R21 MH075027 to M.T.T; R01 MH062066 to E.F.W.; K05 MH01654 to T.H.M.; and U01 MH066160 to S.W.W.); the Donaghue Foundation (to S.W.W.); and Eli Lilly and Co. (study HGGF to T.H.M., J.A., D.O.P.).
• Keywords: Male; Longitudinal Studies; Adolescent; Social Adjustment; Schizophrenia; Risk; Humans; Female; Schizophrenic Psychology; Prodromal Symptoms; Psychotic Disorders
• Research Categories: Psychology, Clinical

Abstract

Deterioration in premorbid functioning is a common feature of schizophrenia, but sensitivity to psychosis conversion among clinical high-risk samples has not been examined. This study evaluates premorbid functioning as a predictor of psychosis conversion among a clinical high-risk sample, controlling for effects of prior developmental periods. Participants were 270 clinical high-risk individuals in the North American Prodrome Longitudinal Study - I, 78 of whom converted to psychosis over the next 2.5 years. Social, academic, and total maladjustment in childhood, early adolescence, and late adolescence were rated using the Cannon-Spoor Premorbid Adjustment Scale. Early adolescent social dysfunction significantly predicted conversion to psychosis (hazard ratio = 1.30, p =.014), independently of childhood social maladjustment and independently of severity of most baseline positive and negative prodromal symptoms. Baseline prodromal symptoms of disorganized communication, social anhedonia, suspiciousness, and diminished ideational richness mediated this association. Early adolescent social maladjustment and baseline suspiciousness together demonstrated moderate positive predictive power (59%) and high specificity (92.1%) in predicting conversion. Deterioration of academic and total functioning, although observed, did not predict conversion to psychosis. Results indicate early adolescent social dysfunction to be an important early predictor of conversion. As such, it may be a good candidate for inclusion in prediction algorithms and could represent an advantageous target for early intervention.