Trajectories of symptom severity and functioning over a three-year period in a psychosis high-risk sample: A secondary analysis of the Neurapro trial. (January 2020)

• Record Type: Journal Article
• Authors: Hartmann, Jessica A.; Schmidt, Stefanie J.; McGorry, Patrick D.; Berger, Maximus; Berger, Gregor E.; Chen, Eric Y.H.; de Haan, Lieuwe; Hickie, Ian B.; Lavoie, Suzie; Markulev, Connie; Mossaheb, Nilufar; Nieman, Dorien H.; Nordentoft, Merete; Polari, Andrea; Riecher-Rössler, Anita; Schäfer, Miriam R.; Schlögelhofer, Monika; Smesny, Stefan; Thompson, Andrew; Verma, Swapna K.; Yuen, Hok Pan; Yung, Alison R.; Amminger, G. Paul; Nelson, Barnaby
• Is Part Of: Behaviour research and therapy. Volume 124(2020)
• Publication Date: 2020-01
• Subjects: Ultra-high risk -- Psychosis -- Symptom trajectories -- Latent class growth analysis -- Longitudinal; Cognitive therapy -- Periodicals; Psychotherapy -- Periodicals; 616.891
• DOI: 10.1016/j.brat.2019.103527
• Languages: English
• ISSNs: 0005-7967

Abstract

Abstract: The Ultra-High Risk (UHR) for psychosis group is known to be heterogeneous with diverse outcomes. This study aimed to: 1. Identify subclasses of UHR individuals based on trajectories of symptomatic and functional change over time, 2. Identify predictors of these trajectories. A sample of 304 UHR individuals participating in the Neurapro trial were followed over an average of 40 months. All participants received cognitive-behavioural case management (CBCM). Symptomatic and functional profiles were investigated using latent class growth analysis. Multinomial regression was employed to investigate predictors of classes. Identified trajectories showed mostly parallel slopes (i.e. improving symptoms/functioning over time), which were primarily distinct regarding the severity of symptomatology/level of functioning at baseline (i.e. the intercept). Higher symptomatic/lower functioning classes were predicted by higher substance use, older age, female gender, and lower cognitive functioning. No divergent trajectories were identified as all classes improved over time. This may reflect effective treatment through CBCM, natural illness course, or effective engagement with mental health services. Nonetheless, classes highest in symptoms/lowest in functioning still showed considerable impairment during follow-up, highlighting the need for targeted intervention in these subgroups. The study emphasizes the need for more clinical attention directed towards UHR patients being female or using substances. Highlights: In 304 individuals at risk for psychosis, different trajectories were identified. All trajectories showed symptomatic and functional improvements over time. Subgroups with similar trajectories differed in severity of impairments at baseline. Substance use predicted severe risk, depressive and general symptom trajectories. Further predictors were being female, older age, and lower cognitive functioning.