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Psychosocial outcome in patients at clinical high risk of psychosis: a prospective follow-up

Social Psychiatry and Psychiatric Epidemiology volume 48, pages 303–311 (2013)Cite this article

Abstract

Purpose

In patients at clinical high risk (CHR) of psychosis, transition to psychosis has been the focus of recent studies. Their broader outcome has received less attention. We studied psychosocial state and outcome in CHR patients.

Methods

In the European Prediction of Psychosis Study, 244 young help-seeking CHR patients were assessed with the Strauss and Carpenter Prognostic Scale (SCPS) at baseline, and 149 (61.1 %) of them were assessed for the second time at the 18-month follow-up. The followed patients were classified into poor and good outcome groups.

Results

Female gender, ever-married/cohabitating relationship, and good working/studying situation were associated with good baseline SCPS scores. During follow-up, patients’ SCPS scores improved significantly. Good follow-up SCPS scores were predicted by higher level of education, good working/studying status at baseline, and white ethnicity. One-third of the followed CHR patients had poor global outcome. Poor working/studying situation and lower level of education were associated with poor global outcome. Transition to psychosis was associated with baseline, but not with follow-up SCPS scores or with global outcome.

Conclusion

The majority of CHR patients experience good short-term recovery, but one-third have poor psychosocial outcome. Good working situation is the major indicator of good outcome, while low level of education and non-white ethnicity seem to be associated with poor outcome. Transition to psychosis has little effect on psychosocial outcome in CHR patients. In treating CHR patients, clinicians should focus their attention on a broader outcome, and not only on preventing transition to psychosis.

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References

  1. Yung AR, McGorry PD (1996) The prodromal phase of first-episode psychosis: past and current conceptualizations. Schizophr Bull 22:353–370

    PubMed  Article  CAS  Google Scholar 

  2. McGlashan TH, Miller TJ, Woods SW et al. (2001) Structured interview for prodromal syndromes (Version 3.0, unpublished manuscript): PRIME Research Clinic, Yale School of Medicine, New Haven

  3. Cannon TD, Cadenhead K, Cornblatt B, Woods SW, Addington J, Walker E, Seidman LJ, Perkins D, Tsuang M, McGlashan T, Heinssen R (2008) Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Arch Gen Psychiatry 65:28–37

    PubMed  Article  Google Scholar 

  4. Ruhrmann S, Schultze-Lutter F, Salokangas RKR, Heinimaa M, Linszen D, Dingemans P, Birchwood M, Patterson P, Juckel G, Heinz A, Morrison A, Lewis S, Graf von Reventlow H, Klosterkötter J (2010) Prediction of Psychosis in Adolescents and Young Adults at high risk: Results from the Prospective European Prediction of Psychosis Study. Arch Gen Psychiatry 67:241–251

    PubMed  Article  Google Scholar 

  5. Yung AR, Yuen HP, Berger G, Francey S, Hung TC, Nelson B, Phillips L, McGorry P (2007) Declining transition rate in ultra high risk (prodromal) services: dilution or reduction of risk? Schizophr Bull 33:673–681

    PubMed  Article  Google Scholar 

  6. Strauss JR, Carpenter WT (1974) The prediction of outcome in schizophrenia. II. Relationships between predictor and outcome variables. Arch Gen Psychiatry 31:37–42

    PubMed  Article  CAS  Google Scholar 

  7. Strauss JS, Carpenter WT Jr (1977) Prediction of outcome in schizophrenia III: five-year outcome and its predictors. Arch Gen Psychiatry 34:159–163

    PubMed  Article  CAS  Google Scholar 

  8. Carpenter WT Jr, Strauss JS (1991) The prediction of outcome in schizophrenia IV: eleven-year follow-up of the Washington IPSS cohort. J Nerv Ment Dis 179:517–525

    PubMed  Article  Google Scholar 

  9. Poirier S, Bureau V, Lehoux C, Bouchard RH, Maziade M, Pelletier S, René L, Trépanier J, Emond C, Mérette C, Roy MA (2004) A factor analysis of the Strauss and Carpenter revised outcome criteria scale: a validation of the French translation. J Nerv Ment Dis 192:864–867

    PubMed  Article  Google Scholar 

  10. Klosterkötter J, Ruhrmann S, Schultze-Lutter F, Salokangas RKR, Linszen D, Birchwood M, Juckel G, Morrison A, Vázquèz-Barquero, Hambrecht M, von Reventlow H, on behalf of the EPOS group (2005) The European Prediction of Psychosis Study (EPOS): integrating early recognition and intervention in Europe. World Psychiatry 4:161–167

    Google Scholar 

  11. Schultze-Lutter F, Klosterkötter J (2002) Bonn Scale for Assessment of Basic Symptoms–Prediction List, BSABS-P. University of Cologne, Cologne

    Google Scholar 

  12. First MB, Spitzer RL, Gibbon M, Williams JBW (1997) Structured clinical interview for DSM-IV axis I disorders (SCID-I). American Psychiatric Publishing, Arlington

    Google Scholar 

  13. Kokes RF, Strauss JS, Klorman R (1977) Premorbid adjustment in schizophrenia. Part II: measuring premorbid adjustment: the instruments and their development. Schizophr Bull 3:186–213

    PubMed  Article  CAS  Google Scholar 

  14. Händel M, Bailer J, Bräuer W, Laubenstein D, Rey ER (1996) The prognostic scale by Strauss and Carpenter and its validity. Eur Arch Psychiatry Clin Neurosci 246:203–208

    PubMed  Article  Google Scholar 

  15. Wieselgren IM, Lindstrom LH (1996) A prospective 1–5 year outcome study in first-admitted and readmitted schizophrenic patients; relationship to heredity, premorbid adjustment, duration of disease and education level at index admission and neuroleptic treatment. Acta Psychiatr Scand 93:9–19

    PubMed  Article  CAS  Google Scholar 

  16. Schennach-Wolff R, Meyer S, Seemüller F, Jäger M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Maier W, Lemke MR, Rüther E, Klingberg S, Gastpar M, Möller HJ, Riedel M (2011) Influencing factors and predictors of early improvement in the acute treatment of schizophrenia and schizophrenia spectrum disorder. J Psychiatr Res 45:1639–1647

    PubMed  Article  Google Scholar 

  17. Salokangas RKR (1978) Psychosocial prognosis in schizophrenia. Formation of the prognosis for schizophrenic patients: a multivariate analysis. Annales Universitatis Turkuensis. Ser. D. University of Turku, Turku

  18. Salokangas RKR (1983) Prognostic implications of the sex of schizophrenic patients. Br J Psychiatry 142:145–151

    PubMed  Article  CAS  Google Scholar 

  19. Beiser M, Bean G, Erickson D, Zhang J, Iacono WG, Rector NA (1994) Biological and psychosocial predictors of job performance following a first episode of psychosis. Am J Psychiatry 151:857–863

    PubMed  CAS  Google Scholar 

  20. Shrivastava A, Shah N, Johnston M, Stitt L, Thakar M (2010) Predictors of long-term outcome of first-episode schizophrenia: a ten-year follow-up study. Ind J Psychiatry 52:320–326

    Article  Google Scholar 

  21. Mausbach BT, Moore R, Bowie C, Cardenas V, Patterson TL (2009) A review of instruments for measuring functional recovery in those diagnosed with psychosis. Schizophr Bull 35:307–318

    PubMed  Article  Google Scholar 

  22. Tsang HW, Leung AY, Chung RC, Bell M, Cheung WM (2010) Review on vocational predictors: a systematic review of predictors of vocational outcomes among individuals with schizophrenia: an update since 1998. Aust NZ J Psychiat 44:495–504

    Article  Google Scholar 

  23. Ramsay CE, Stewart T, Compton MT (2012) Unemployment among patients with newly diagnosed first-episode psychosis: prevalence and clinical correlates in a US sample. Soc Psychiatry Psychiatr Epidemiol 47:797–803

    PubMed  Article  Google Scholar 

  24. Lehman AF (1995) Vocational rehabilitation in schizophrenia. Schizophr Bull 21:645–656

    PubMed  Article  CAS  Google Scholar 

  25. Bond GR (1998) Principles of the individual placement and support model: empirical support. Psychiatr Rehabil J 22:11–23

    Google Scholar 

  26. Wexler BE, Bell MD (2005) Cognitive remediation and vocational rehabilitation for schizophrenia. Schizophr Bull 31:931–941

    PubMed  Article  Google Scholar 

  27. Jarbin H, Hansson L (2004) Adult quality of life and associated factors in adolescent onset schizophrenia and affective psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 39:725–729

    PubMed  Article  Google Scholar 

  28. Gittelman-Klein R, Klein DF (1969) Premorbid asocial adjustment and prognosis in schizophrenia. J Psychiatr Res 7:35–53

    PubMed  Article  CAS  Google Scholar 

  29. Alanen YO, Räkköläinen V, Laakso J, Rasimus R, Kaljonen A (1986) Towards need-specific treatment of schizophrenic psychoses. Springer, Heidelberg

    Book  Google Scholar 

  30. Seeman MV (1986) Current outcome in schizophrenia: women vs. men. Acta Psychiatr Scand 73:609–617

    PubMed  Article  CAS  Google Scholar 

  31. Salokangas RKR, Stengård E (1990) Gender and short-term outcome in schizophrenia. Schizophr Res 3:333–345

    PubMed  Article  CAS  Google Scholar 

  32. Tamminga CA (1997) Gender and schizophrenia. J Clin Psychiatry 58(Suppl 15):33–37

    PubMed  Google Scholar 

  33. Riecher-Rössler A, Häfner H (2000) Gender aspects in schizophrenia: bridging the border between social and biological psychiatry. Acta Psychiatr Scand Suppl 407:58–62

    PubMed  Article  Google Scholar 

  34. Morgan VA, Castle DJ, Jablensky AV (2008) Do women express and experience psychosis differently from men? Epidemiological evidence from the Australian National Study of Low Prevalence (Psychotic) Disorders. Aust NZ J Psychiatry 42:74–82

    Article  Google Scholar 

  35. Cotton SM, Wright A, Harris MG, Jorm AF, McGorry PD (2006) Influence of gender on mental health literacy in young Australians. Aust NZ J Psychiat 40:790–796

    Article  Google Scholar 

  36. Salokangas RKR, Honkonen T, Stengård E, Koivisto A-M (2001) To be or not to be married: that is the question of quality of life in men with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 36:381–390

    PubMed  Article  CAS  Google Scholar 

  37. Thorup A, Petersen L, Jeppesen P, Øhlenschlaeger J, Christensen T, Krarup G, Jørgensen P, Nordentoft M (2006) Social network among young adults with first-episode schizophrenia spectrum disorders: results from the Danish OPUS trial. Soc Psychiatry Psychiatr Epidemiol 41:761–770

    PubMed  Article  Google Scholar 

  38. Cooper B (2005) Schizophrenia, social class and immigrant status: the epidemiological evidence. Epidemiol Psichiatr Soc 14:137–144

    PubMed  Article  Google Scholar 

  39. Brugha T, Jenkins R, Bebbington P, Meltzer H, Lewis G, Farrell M (2004) Risk factors and the prevalence of neurosis and psychosis in ethnic groups in Great Britain. Soc Psychiatry Psychiatr Epidemiol 39:939–946

    PubMed  Article  Google Scholar 

  40. McGovern D, Hemmings P, Cope R, Lowerson A (1994) Long-term follow-up of young Afro-Caribbean Britons and white Britons with a first admission diagnosis of schizophrenia. Soc Psychiatry Psychiatr Epidemiol 29:8–19

    PubMed  CAS  Google Scholar 

  41. Bae SW, Brekke JS, Bola JR (2004) Ethnicity and treatment outcome variation in schizophrenia: a longitudinal study of community-based psychosocial rehabilitation interventions. J Nerv Ment Dis 192:623–628

    PubMed  Article  Google Scholar 

  42. Salokangas RKR, Räkköläinen V, Alanen Y (1989) Maintenance of grip on life and goals of life: a valuable criterion for evaluating outcome in schizophrenia. Acta Psychiatr Scand 80:187–193

    PubMed  Article  CAS  Google Scholar 

  43. Schlosser DA, Jacobson S, Chen Q, Sugar CA, Niendam TA, Li G, Bearden CE, Cannon TD (2011) Recovery from an at-risk state: clinical and functional outcomes of putatively prodromal youth who do not develop psychosis. Schizophr Bull Aug 8. [Epub ahead of print]

  44. McGlashan TH (1998) Early detection and intervention of schizophrenia: rationale and research. Br J Psychiatry Suppl 172:3–6

    PubMed  CAS  Google Scholar 

  45. Salokangas RKR, McGlashan TH (2008) Early detection and intervention of psychosis. A review. Nord J Psychiatry 62:92–105

    Article  Google Scholar 

  46. Klosterkötter J, Schultze-Lutter F, Bechdolf A, Ruhrmann S (2011) Prediction and prevention of schizophrenia: what has been achieved and where to go next? World Psychiatry 10:165–174

    PubMed  Google Scholar 

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Acknowledgments

This study was funded by the grant QLG4-CT-2001-01081 from the 5th Framework Program Quality of Life and Management of Living Resources of the European Commission. Additional local funding was provided by the Social Insurance Institution of Finland and the Medical Faculty of Cologne (Köln Fortune Program). Professor Birchwood and Dr Patterson were part funded by the National Institute for Health Research (NIHR) through the Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country (CLAHRC-BBC)’.

Conflict of interest

None.

Author information

Affiliations

  1. Department of Psychiatry, University of Turku, 20520, Turku, Finland

    Raimo K. R. Salokangas, Markus Heinimaa, Sinikka Luutonen & Tiina From

  2. Psychiatric Clinic, Turku University Central Hospital, Turku, Finland

    Raimo K. R. Salokangas & Sinikka Luutonen

  3. Turku Psychiatric Clinic, Turku Mental Health Centre, Turku, Finland

    Raimo K. R. Salokangas

  4. Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands

    Dorien H. Nieman & Don Linszen

  5. Department of Psychiatry, University of Helsinki, Helsinki, Finland

    Tanja Svirskis

  6. Peijas Hospital, Helsinki University Central Hospital, Helsinki, Finland

    Tanja Svirskis

  7. Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, Bochum, Germany

    Heinrich Graf von Reventlow & Georg Juckel

  8. Department of Psychiatry and Psychology, University of Maastricht, Maastricht, Netherlands

    Don Linszen

  9. Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands

    Peter Dingemans

  10. Mediant, Enschede, Netherlands

    Peter Dingemans

  11. School of Psychology, University of Birmingham, Birmingham, UK

    Max Birchwood

  12. Youthspace, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK

    Paul Patterson

  13. University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland

    Frauke Schultze-Lutter

  14. Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany

    Joachim Klosterkötter & Stephan Ruhrmann

Authors
  1. Raimo K. R. Salokangas
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  2. Dorien H. Nieman
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  3. Markus Heinimaa
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  6. Tiina From
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  7. Heinrich Graf von Reventlow
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  8. Georg Juckel
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  9. Don Linszen
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  10. Peter Dingemans
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  11. Max Birchwood
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  12. Paul Patterson
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  13. Frauke Schultze-Lutter
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  14. Joachim Klosterkötter
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  15. Stephan Ruhrmann
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Consortia

The EPOS group

Corresponding author

Correspondence to Raimo K. R. Salokangas.

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Salokangas, R.K.R., Nieman, D.H., Heinimaa, M. et al. Psychosocial outcome in patients at clinical high risk of psychosis: a prospective follow-up. Soc Psychiatry Psychiatr Epidemiol 48, 303–311 (2013). https://doi.org/10.1007/s00127-012-0545-2

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  • DOI: https://doi.org/10.1007/s00127-012-0545-2

Keywords

  • Clinical high-risk patients
  • Straus and Carpenter Prognostic Scale
  • Prospective follow-up
  • Psychosocial outcome