M127. Baseline Psychopathology as Predictors of Functional Outcome in Attenuated and Early First Episode Psychosis

Abstract

Background: As efforts intensify to identify and intervene early among those at risk for psychosis, examination of the predictive relationship between presenting psychopathology and functional outcome may guide treatment decision-making and offer a means to prevent or reduce chronic disability. Methods: Data were collected through the Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP), a multisite national trial examining conversion rates and treatment effcacy for youth at risk of developing psychosis. Participants were followed prospectively and completed comprehensive evaluations at 6, 12, and 24 months, including the Structured Interview for Psychosis-Risk Syndromes (SIPS), Heinrich Quality of Life Scale, and the Global Functioning Social and Role Scales. Our previous analysis including 334 participants at baseline (87 clinical low-risk, 205 clinical high-risk, and 45 early frst episode psychosis) identi-fed 4 empirical factors of the Scale of Prodromal Symptoms portion of the SIPS: positive symptoms, distress, negative symptoms, and deteriorated thought process. The present analyses included the same 334 participants and examined the predictive value of these baseline symptom factors in cross-sectional and longitudinal quality of life and 24-month global social and role functioning using Pearson's correlation and simultaneous regression analyses. Results: Baseline negative symptoms and deteriorated thought process were consistently signifcantly associated with worse functional ratings across time points (rs ranging from-.16 to-.59), while positive symptoms and distress were minimally predictive. Regression analyses demonstrated that negative symptoms tended to be the most robust predictor of functional impairment at baseline, 6 months, and 12 months (accounting for 3%-28% of unique variance), and at 2-year follow-up both negative symptoms and deteriorated thought process signifcantly predicted dysfunction (accounting for 3%-4% of unique variance). Conclusion: Consistent with the literature in individuals with chronic psychosis/schizophrenia, positive symptoms may be distressing and attract attention clinically but they are not strongly associated with functioning. On the contrary, negative symptoms and thought disorder appear to predict functional outcome for up to 2 years among adolescents and young adults at risk for psychosis (perhaps after positive symptoms and distress partially remit with treatment). However, the proportion of variance accounted for by these variables was small, suggesting that a multitude of factors may affect functioning (eg, cognition, educational attainment, sub-stance use, etc.). Nevertheless, developing effective interventions to target negative symptoms and disordered thought process may be critical to promote functional recovery among those experiencing attenuated symptoms or a frst episode of psychosis.