Prediction of functional outcome in young patients with a recent-onset psychiatric disorder: Beyond the traditional diagnostic classification system

Abstract

A critical research goal is to identify modifiable risk factors leading to functional disabilities in young psychiatric patients. The authors developed a multidimensional trans-diagnostic predictive model of functional outcome in patients with the recent-onset of a psychiatric illness. Baseline clinical, psychosis-risk status, cognitive, neurological-soft-signs measures, and dopamine-related-gene polymorphisms (DRD1-rs4532, COMT-rs165599, and DRD4-rs1800955) were collected in 138 young non-psychotic outpatients. 116 individuals underwent follow-up (mean=2.2years, SD=0.9) examination. A binary logistic model was used to predict low-functioning status at follow-up as defined by a score lower than 65 in the social occupational functioning assessment scale. A total of 54% of patients experiences low functioning at follow-up. Attention, Avolition, and Motor-Coordination subscale were significant predictors of low-functioning with an accuracy of 79.7%. A non-significant trend was found for a dopamine-related-gene polymorphism (DRD1-rs4532). The model was independent of psychotic-risk status, DSM-diagnosis, and psychotic conversion. A trans-diagnostic approach taking into account specific neurocognitive, clinical, and neurological information has the potential to identify those individuals with low-functioning independent of DSM diagnosis or the level of psychosis-risk. Specific early interventions targeting modifiable risk factors and emphasize functional recovery in young psychiatric samples, independent of DSM-diagnosis and psychosis-risk, are essential.

Negative Symptoms and Functioning in Youth at Risk of Psychosis: A Systematic Review and Meta-analysis

“…These results are similar to both persistent negative symptom and deficits syndrome subgroup studies in schizophrenia in that they often demonstrate greater deficits in functioning. [71][72][73][74][75][76] In terms of prediction models, negative symptoms contributed to the prediction of lower functioning across multiple studies. These findings are similar to research conducted in patients with schizophrenia where negative symptoms have consistently been shown to be a significant contributor to lower functioning [94][95][96] and in some cases negative symptoms demonstrate a stronger risk factor for lower functioning than positive psychotic symptoms in schizophrenia.…”

“…Several studies demonstrated that negative symptoms contributed to the prediction of lower functioning. One study demonstrated that avolition, attention, and motor-coordination were significant predictors of poorer functioning 71 while another study showed that anhedonia-asociality, attention disturbances, and disorder of thought content predicted poorer functioning. 72 Next, a combination of increased negative symptoms and reduced performance on a verbal recall task was the best predictor of poor functional outcome.…”

A systematic review of the prognostic value of motor abnormalities on clinical outcome in psychosis

“…One study identified NSS at baseline as a key predictor of low social functioning at one-year follow-up in adolescents with a recent-onset psychiatric disorder (Minichino et al, 2017). Another study related spontaneous dyskinesia at baseline to poor social functioning at two-year follow-up in adolescents at high-risk for psychosis (Mittal et al, 2011).…”

“…In CHR populations, NSS and dyskinesia have been related to transition to psychosis (Callaway et al, 2014;Francesconi et al, 2017;Masucci et al, 2018;Mittal et al, 2007a, b). In patients with FEP, spontaneous MAs have shown predictive value for symptom severity, cognitive functioning and long-term psychosocial outcome (Cuesta et al, 2014(Cuesta et al, , 2018Minichino et al, 2017;White et al, 2009). In a chronic schizophrenia sample of 2175 participants, tardive dyskinesia was significantly associated with symptom severity, lower remission rates, lower levels of quality of life and psychosocial functioning at 3-year follow-up (Ascher-Svanum et al, 2008).…”