Introduction
Only about one third of patients at high risk for psychosis based on
current clinical criteria convert to a psychotic disorder within a 2.5-year
follow-up period. Targeting clinical high-risk (CHR) individuals for
preventive interventions could expose many to unnecessary treatments,
underscoring the need to enhance predictive accuracy with non-clinical
measures. Candidate measures include event-related potential (ERP)
components with established sensitivity to schizophrenia. Here we examined
the mismatch negativity (MMN) component of the ERP elicited automatically by
auditory deviance in CHR and early illness schizophrenia (ESZ) patients. We
also examined whether MMN predicted subsequent conversion to psychosis in
CHR patients.
Method
MMN to auditory deviants (duration, frequency, and duration+frequency
“double deviant”) were assessed in 44 healthy controls (HC),
19 ESZ, and 38 CHR patients. Within CHR patients, 15 converters to psychosis
were compared to 16 non-converters with at least 12 months of clinical
follow-up. Hierarchical Cox regression examined the ability of MMN to
predict time to psychosis onset in CHR patients.
Results
Irrespective of deviant type, MMN was significantly reduced in ESZ
and CHR patients relative to HC, and in CHR converters relative to
non-converters. MMN did not significantly differentiate ESZ and CHR
patients. The duration+frequency double deviant MMN, but not the single
deviant MMNs, significantly predicted the time to psychosis onset in CHR
patients.
Conclusions
Neurophysiological mechanisms underlying automatic processing of
auditory deviance, as reflected by the duration+frequency double deviant
MMN, are compromised prior to psychosis onset, and can enhance the
prediction of psychosis risk among CHR patients.