Distress Related to Attenuated Psychotic Symptoms: Static and Dynamic Association With Transition to Psychosis, Nonremission, and Transdiagnostic Symptomatology in Clinical High-Risk Patients in an International Intervention Trial

Abstract

This study examined whether distress in relation to attenuated psychotic symptoms (DAPS) is associated with clinical outcomes in an ultra-high-risk (UHR) for psychosis sample. We also investigated whether DAPS is associated with cognitive style (attributional style and cognitive biases) and whether amount of psychosocial treatment provided is associated with reduction in DAPS. The study was a secondary analysis of the ‘Neurapro’ clinical trial of omega-3 fatty acids. 304 UHR patients were recruited across ten early intervention services. Data from baseline assessment, regular assessments over 12 months and medium term follow up (mean=3.4 years) were used for analysis. Findings indicated: a positive association between DAPS assessed over time and transition to psychosis; a significant positive association between baseline and longitudinal DAPS and transdiagnostic clinical and functional outcomes; a significant positive association between baseline and longitudinal DAPS and non-remission of UHR status. There was no relationship between severity of DAPS and cognitive style. A greater amount of psychosocial treatment (cognitive-behavioural case management) was associated with an increase in DAPS scores. The study indicates that UHR patients who are more distressed by their attenuated psychotic symptoms are more likely to have a poorer clinical trajectory transdiagnostically. Assessment of DAPS may therefore function as a useful marker of risk for a range of poor outcomes. The findings underline the value of repeated assessment of variables and incorporation of dynamic change into predictive modelling. More research is required into mechanisms driving distress associated with symptoms and the possible bidirectional relationship between symptom severity and associated distress.

RETRACTED: Dynamic Prediction of Outcomes for Youth at Clinical High Risk for Psychosis

“…A major strength of this study is the empirical approach to the feature selection process, which also leverages longitudinal information in evaluating likelihood of achieving later clinical outcomes. Previous studies also showed an increase in discrimination between converters and nonconverters with joint modeling compared with baseline models [19][20][21] ; however, contrary to these studies, which rely only on baseline information to select longitudinal variables, this approach forecasts longitudinal outcomes with short-term longitudinal data in addition to baseline data. In addition, in examining both conversion to psychosis and symptom remission in parallel, we shed light on the distinctive presentations and progressions of each of these groups.…”

“…In the CHR-P population, a handful of studies using this approach have shown how change in predictor variables can inform risk of transition to psychosis . For example, continued high levels of distress associated with attenuated psychotic symptoms were found to improve prediction of conversion, but this and the other available joint models remain to be validated. While these initial findings are promising for the feasibility of implementing joint modeling within the CHR-P population, they did not identify the longitudinally changing features most useful for prediction, instead relying on change in features selected for the baseline model, and did not examine differential patterns of short-term clinical change among those who convert vs remit.…”

“…One approach to incorporate longitudinal information into risk prediction of future outcomes is joint modeling, which combines both longitudinal mixed-effects models and time-to-event survival analyses . In the CHR-P population, a handful of studies using this approach have shown how change in predictor variables can inform risk of transition to psychosis . For example, continued high levels of distress associated with attenuated psychotic symptoms were found to improve prediction of conversion, but this and the other available joint models remain to be validated.…”

The MAC‐P program: A pilot study of a mindfulness and compassion program for youth with psychotic experiences

“…The findings have important clinical implications. Nelson et al (2020) found that ARMS clients who are more distressed by their attenuated psychotic symptoms (DAPS) have a poorer clinical trajectory transdiagnostically and greater compromised functioning. An increase in self‐compassion was associated with a decrease in DAPS.…”

Prediction of clinical outcomes beyond psychosis in the ultra‐high risk for psychosis population

“…The trial's methodology and clinical outcomes have been described in detail elsewhere (Markulev et al, 2015;McGorry et al, 2017;Nelson et al, 2018). The main results of the Neurapro study indicated no differences in transition rates, symptomatology and functioning between the PUFAs and Placebo groups at month-12 (McGorry et al, 2017;Polari et al, 2018b) and at medium-term follow-up (Nelson et al, 2018), allowing for the pooling of the two treatment groups for the purpose of the current study, an approach that has been used elsewhere (Berger et al, 2019;Hartmann et al, 2017Hartmann et al, , 2020Nelson et al, 2020).…”