The Relationship Between Grey Matter Volume and Clinical and Functional Outcomes in People at Clinical High Risk for Psychosis

Tognin, Stefania; Richter, Anja; Kempton, Matthew J.; Modinos, Gemma; Antoniades, Mathilde; Azis, Matilda; Allen, Paul; Bossong, Matthijs G.; Pérez, Jesús; Pantelis, Christos; Nelson, Barnaby; Amminger, G. Paul; Riecher‐Rössler, Anita; Barrantes‐Vidal, Neus; Krebs, Marie‐Odile; Glenthøj, Birte; Ruhrmann, Stephan; Sachs, Gabriele; Rutten, Bart P. F.; Haan, Lieuwe de; Gaag, Mark van der; Valmaggia, Lucia; McGuire, Philip

doi:10.1093/schizbullopen/sgac040

Cited by 3 publications

(1 citation statement)

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“…Recruitment rates and low level of dropouts indicate that implementing IPS within OASIS is feasible. Although several participants were in some form of employment at baseline, the level of functioning was low as measured by the SOFAS and GAF, and comparable to other similar samples (Mongan et al, 2021; Tognin et al, 2022). In addition, the participant’s level of functioning and clinical symptoms at baseline, and the relatively high (Salazar de Pablo et al, 2021) 6-month transition to psychosis rate (12.9%) at follow-up, demonstrated the feasibility of real-life clinical setting implementation.…”

Section: Discussionsupporting

confidence: 66%

Individual placement and support focusing on employment and education for young people at clinical high risk of psychosis: A feasibility study.

Del Piccolo,

Valmaggia,

Henderson

et al. 2024

Psychiatric Rehabilitation Journal

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Objective: This study aimed to assess the feasibility of implementing Individual Placement and Support (IPS) with a focus on educational and employment goals, within a clinical service for the early detection of individuals at clinical high risk (CHR) of psychosis. Method: Between June 2019 and April 2021, participants were recruited and received up to 6 (± 2) months support. Primary outcome: Enrolled participants, attended sessions, and disengagement rates were analyzed to assess feasibility. Secondary Outcomes: Enrollment in mainstream education or/and employment, hours spent working or/and studying, salary, level of functioning, and self-efficacy at baseline and follow-up were compared. Results: Thirty-one participants were recruited, 13 of whom were remotely recruited after the first COVID-19 lockdown. Dropout rates were relatively low (16.1%), and 26 participants (83.9%) completed the program. Each participant received on average nine sessions (M = 9.65; SD = 4.92). Secondary outcomes: At follow-up, 73.1% participants were employed, working on average more hours per week, t(25) = −2.725; p = .012, and were earning significantly more money, t(25) = −3.702; p = .001, compared to baseline. Gains in educational outcomes were less clear. Global Assessment of Functioning, t = 248.50; p = .001, and Social Occupational Functioning, t(25) = −3.273; p = .003, were significantly higher at 6-month follow-up compared to baseline. No differences were found in participants' self-efficacy. Conclusions and Implications for Practice: Findings indicate that research procedures are appropriate and that IPS implementation within a CHR clinical team is feasible. Secondary outcomes also suggest that IPS may be a beneficial intervention for young people at CHR. A longer follow-up might be needed to assess its impact on educational outcomes. Impact and ImplicationsFindings from this study indicate that Individual Placement and Support (IPS) implementation within a clinical high risk (CHR) of psychosis service is feasible. Secondary outcomes also suggest that IPS may be a beneficial intervention for young people at CHR. Finally, a longer follow-up might be needed to assess its impact on educational outcomes.

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Section: Discussionsupporting

confidence: 66%

Individual placement and support focusing on employment and education for young people at clinical high risk of psychosis: A feasibility study.

Del Piccolo,

Valmaggia,

Henderson

et al. 2024

Psychiatric Rehabilitation Journal

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View full text Add to dashboard Cite

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Timeframe for Conversion to Psychosis From Individuals at Clinical High-Risk: A Quantile Regression

Zhang,

Wei,

Tang

et al. 2024

Schizophrenia Bulletin

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Background and Hypothesis The time taken for an individual who is at the clinical high-risk (CHR) stage to transition to full-blown psychosis may vary from months to years. This temporal aspect, known as the timeframe for conversion to psychosis (TCP), is a crucial but relatively underexplored dimension of psychosis development. Study Design The sample consisted of 145 individuals with CHR who completed a 5-year follow-up with a confirmed transition to psychosis within this period. Clinical variables along with functional variables such as the Global Assessment of Function (GAF) score at baseline (GAF baseline) and GAF-drop from the highest score in the past year. The TCP was defined as the duration from CHR identification to psychosis conversion. Participants were categorized into 3 groups based on TCP: “short” (≤6 months, ≤33.3%), “median” (7–17 months, 33.3%–66.6%), and “long” (≥18 months, ≥66.6%). The quantile regression analysis was applied. Study Results The overall sample had a median TCP of 11 months. Significant differences among the three TCP groups were observed, particularly in GAF-drop (χ2 = 8.806, P = .012), disorganized symptoms (χ2 = 7.071, P = .029), and general symptoms (χ2 = 6.586, P = .037). Greater disorganized symptoms (odds ratio [OR] = 0.824, P = .009) and GAF-drop (OR = 0.867, P = .011) were significantly associated with a shorter TCP, whereas greater general symptoms (OR = 1.198, P = .012) predicted a longer TCP. Quantile regression analysis demonstrated a positive association between TCP and GAF baseline above the 0.7 quantile and a negative association between TCP rank and GAF drop below the 0.5 quantile. Conclusions This study underscores the pivotal role of functional characteristics in shaping TCP among individuals with CHR, emphasizing the necessity for a comprehensive consideration of temporal aspects in early prevention efforts.

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Do Cognitive Subtypes Exist in People at Clinical High Risk for Psychosis? Results From the EU-GEI Study

Gifford,

Avila,

Kempton

et al. 2024

Schizophrenia Bulletin

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Background and Hypothesis Cognition has been associated with socio-occupational functioning in individuals at Clinical High Risk for Psychosis (CHR-P). The present study hypothesized that clustering CHR-P participants based on cognitive data could reveal clinically meaningful subtypes. Study Design A cohort of 291 CHR-P subjects was recruited through the multicentre EU-GEI high-risk study. We explored whether an underlying cluster structure was present in the cognition data. Clustering of cognition data was performed using k-means clustering and density-based spatial clustering of applications with noise. Cognitive subtypes were validated by comparing differences in functioning, psychosis symptoms, transition outcome, and grey matter volume between clusters. Network analysis was used to further examine relationships between cognition scores and clinical symptoms. Study Results No underlying cluster structure was found in the cognitive data. K-means clustering produced “spared” and “impaired” cognition clusters similar to those reported in previous studies. However, these clusters were not associated with differences in functioning, symptomatology, outcome, or grey matter volume. Network analysis identified cognition and symptoms/functioning measures that formed separate subnetworks of associations. Conclusions Stratifying patients according to cognitive performance has the potential to inform clinical care. However, we did not find evidence of cognitive clusters in this CHR-P sample. We suggest that care needs to be taken in inferring the existence of distinct cognitive subtypes from unsupervised learning studies. Future research in CHR-P samples could explore the existence of cognitive subtypes across a wider range of cognitive domains.

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The Relationship Between Grey Matter Volume and Clinical and Functional Outcomes in People at Clinical High Risk for Psychosis

Cited by 3 publications

References 64 publications

Individual placement and support focusing on employment and education for young people at clinical high risk of psychosis: A feasibility study.

Individual placement and support focusing on employment and education for young people at clinical high risk of psychosis: A feasibility study.

Timeframe for Conversion to Psychosis From Individuals at Clinical High-Risk: A Quantile Regression

Do Cognitive Subtypes Exist in People at Clinical High Risk for Psychosis? Results From the EU-GEI Study

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