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

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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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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

Authors and 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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  7. Heinrich Graf von Reventlow
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  8. Georg Juckel
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  9. Don Linszen
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  12. Paul Patterson
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  13. Frauke Schultze-Lutter
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  15. Stephan Ruhrmann
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The EPOS group

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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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