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Premorbid functional development and conversion to psychosis in clinical high-risk youths

Published online by Cambridge University Press:  08 November 2013

Sarah I. Tarbox ,
Jean Addington ,
Kristin S. Cadenhead ,
Tyrone D. Cannon ,
Barbara A. Cornblatt ,
Diana O. Perkins ,
Larry J. Seidman ,
Ming T. Tsuang ,
Elaine F. Walker  and
Robert Heinssen
...Show all authors
Sarah I. Tarbox*
Affiliation:
Yale University School of Medicine
Jean Addington
Affiliation:
University of Calgary
Kristin S. Cadenhead
Affiliation:
University of California, San Diego
Tyrone D. Cannon
Affiliation:
University of California, Los Angeles
Barbara A. Cornblatt
Affiliation:
Zucker Hillside Hospital Albert Einstein College of Medicine Feinstein Institute for Medical Research
Diana O. Perkins
Affiliation:
University of North Carolina at Chapel Hill
Larry J. Seidman
Affiliation:
Harvard Medical School
Ming T. Tsuang
Affiliation:
University of California, San Diego Harvard Institute of Psychiatric Epidemiology and Genetics
Elaine F. Walker
Affiliation:
Emory University
Robert Heinssen
Affiliation:
National Institute of Mental Health
Thomas H. McGlashan
Affiliation:
Yale University School of Medicine
Scott W. Woods
Affiliation:
Yale University School of Medicine
*
Address correspondence and reprint requests to: Sarah I. Tarbox, PRIME Research Clinic, Connecticut Mental Health Center, Yale University School of Medicine, 34 Park Street, B-38, New Haven, CT 06519; E-mail: sarah.tarbox@yale.edu.
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Abstract

Deterioration in premorbid functioning is a common feature of schizophrenia, but sensitivity to psychosis conversion among clinical high-risk samples has not been examined. This study evaluates premorbid functioning as a predictor of psychosis conversion among a clinical high-risk sample, controlling for effects of prior developmental periods. Participants were 270 clinical high-risk individuals in the North American Prodrome Longitudinal Study—I, 78 of whom converted to psychosis over the next 2.5 years. Social, academic, and total maladjustment in childhood, early adolescence, and late adolescence were rated using the Cannon–Spoor Premorbid Adjustment Scale. Early adolescent social dysfunction significantly predicted conversion to psychosis (hazard ratio = 1.30, p = .014), independently of childhood social maladjustment and independently of severity of most baseline positive and negative prodromal symptoms. Baseline prodromal symptoms of disorganized communication, social anhedonia, suspiciousness, and diminished ideational richness mediated this association. Early adolescent social maladjustment and baseline suspiciousness together demonstrated moderate positive predictive power (59%) and high specificity (92.1%) in predicting conversion. Deterioration of academic and total functioning, although observed, did not predict conversion to psychosis. Results indicate early adolescent social dysfunction to be an important early predictor of conversion. As such, it may be a good candidate for inclusion in prediction algorithms and could represent an advantageous target for early intervention.

Type
Regular Articles
Information
Development and Psychopathology , Volume 25 , Issue 4pt1 , November 2013 , pp. 1171 - 1186
Copyright
Copyright © Cambridge University Press 2013 

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References

Addington, J., & Addington, D. (2005). Patterns of premorbid functioning in first episode psychosis: Relationship to 2-year outcome. Acta Psychiatrica Scandinavica, 112, 40–46.CrossRefGoogle ScholarPubMed
Addington, J., Cadenhead, K. S., Cannon, T. D., Cornblatt, B., McGlashan, T. H., Perkins, D. O., et al. (2007). North American Prodrome Longitudinal Study: A collaborative multisite approach to prodromal schizophrenia research. Schizophrenia Bulletin, 33, 665–672.CrossRefGoogle ScholarPubMed
Addington, J., Cornblatt, B., Cadenhead, K. S., Cannon, T. D., McGlashan, T. H., Perkins, D. O., et al. (2011). At clinical high risk for psychosis: Outcome for nonconverters. American Journal of Psychiatry, 168, 800–805.CrossRefGoogle ScholarPubMed
Addington, J., Penn, D., Woods, S. W., Addington, D., & Perkins, D. O. (2008). Social functioning in individuals at clinical high risk for psychosis. Schizophrenia Research, 99, 119–124.CrossRefGoogle ScholarPubMed
Addington, J., van Mastrigt, S., & Addington, D. (2003). Patterns of premorbid functioning in first-episode psychosis: Initial presentation. Schizophrenia Research, 62, 23–30.CrossRefGoogle ScholarPubMed
Allen, D. N., Frantom, L. V., Strauss, G. P., & van Kammen, D. P. (2005). Differential patterns of premorbid academic and social deterioration in patients with schizophrenia. Schizophrenia Research, 75, 389–397.CrossRefGoogle ScholarPubMed
Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.CrossRefGoogle ScholarPubMed
Bellack, A. S., Mueser, K. T., Gingerich, S., & Agresta, J. (2004). Social skills training for schizophrenia: A step-by-step guide. New York: Guilford Press.Google Scholar
Brill, N., Reichenberg, A., Weiser, M., & Rabinowicz, J. (2008). Validity of the Premorbid Adjustment Scale. Schizophrenia Bulletin, 34, 981–983.CrossRefGoogle ScholarPubMed
Cannon, T. D., Cadenhead, K., Cornblatt, B., Woods, S. W., Addington, J., Walker, E., et al. (2008). Prediction of psychosis in youth at high clinical risk: A multisite longitudinal study in North America. Archives of General Psychiatry, 65, 28–37.CrossRefGoogle ScholarPubMed
Cannon-Spoor, H., Potkin, S., & Wyatt, R. (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin, 8, 470–484.CrossRefGoogle ScholarPubMed
Carr, V., Halpin, S., Lau, N., O'Brien, S., Beckmann, J., & Lewin, T. (2000). A risk factor screening and assessment protocol for schizophrenia and related psychosis. Australian and New Zealand Journal of Psychiatry, 34, 170–180.CrossRefGoogle ScholarPubMed
Corcoran, C. M., Kimhy, D., Parrilla-Escobar, M. A., Cressman, V. L., Stanford, A. D., Thompson, J., et al. (2011). The relationship of social function to depressive and negative symptoms in individuals at clinical high risk for psychosis. Psychological Medicine, 41, 251–261.CrossRefGoogle ScholarPubMed
Cornblatt, B. A., Auther, A. M., Neidham, T., Smith, C. W., Zinberg, J., Bearden, C. E., et al. (2007). Preliminary findings for two new measures of social and role functioning in the prodromal phase of schizophrenia. Schizophrenia Bulletin, 33, 688–702.CrossRefGoogle ScholarPubMed
Cornblatt, B. A., Carrion, R. E., Addington, J., Seidman, L., Walker, E. F., Cannon, T. D., et al. (2011). Risk factors for psychosis: Impaired social and role functioning. Schizophrenia Bulletin. Advanced online publication.Google ScholarPubMed
Dragt, S., Nieman, D. H., Veltman, D., Becker, H. E., van de Fliert, R., de Haan, L., et al. (2011). Environmental factors and social adjustment as predictors of a first psychosis in subjects at ultra high risk. Schizophrenia Research, 125, 69–76.CrossRefGoogle ScholarPubMed
Eack, S. M., Pogue-Geile, M. F., Greenwald, D. P., Hogarty, S. S., & Keshavan, M. S. (2010). Mechanisms of functional improvement in a 2-year trial of cognitive enhancement therapy for early schizophrenia. Psychological Medicine, 1–9.Google Scholar
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured Clinical Interview for DSM-IV Axis I disorders, patient edition (SCID-I/P Version 2.0). New York: New York State Psychiatric Institute, Biometrics Research Department.Google Scholar
Haas, G. L., & Sweeney, J. A. (1992). Premorbid and onset features of first-episode schizophrenia. Schizophrenia Bulletin, 16, 373–386.CrossRefGoogle Scholar
Haim, R., Rabinowitz, J., & Bromet, E. (2006). The relationship of premorbid functioning to illness course in schizophrenia and psychotic mood disorders during two years following first hospitalization. Journal of Nervous and Mental Disease, 194, 791–795.CrossRefGoogle ScholarPubMed
Hawkins, K. A., McGlashan, T. H., Quinlan, D., Miller, T. J., Perkins, D. O., Zipursky, R. B., et al. (2004). Factorial structure of the Scale of Prodromal Symptoms. Schizophreia Research, 68, 339–347.CrossRefGoogle ScholarPubMed
Hogarty, G. E., Flesher, S., Ulrich, R., Carter, M., Greenwald, D., Pogue-Geile, M. F., et al. (2004). Cognitive enhancement therapy for schizophrenia: Effects of a 2-year randomized trial on cognition and behavior. Archives of General Psychiatry, 61, 866–876.CrossRefGoogle ScholarPubMed
Ingraham, L. J. (1995). Family-genetic research and schizotypal personality. In Raine, A., Lencz, T., & Mednick, S. A. (Eds.), Schizotypal personality (pp. 19–42). Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Katsanis, J., Iacono, W., & Beiser, M. (1990). Anhedonia and perceptual aberration in first-episode psychotic patients and their relatives. Journal of Abnormal Psychology, 99, 202–206.CrossRefGoogle ScholarPubMed
Kraepelin, E. (1919). Dementia praecox and paraphrenia. Huntington, NY: Krieger.Google Scholar
Larsen, J. K., Friis, S., Haahr, U., Johannessen, J. O., Melle, I., Opjordsmoen, S. R., et al. (2004). Premorbid adjustment in first-episode non-affective psychosis: Distinct patterns of pre-onset course. British Journal of Psychiatry, 185, 108–115.CrossRefGoogle ScholarPubMed
Larsen, T. K., McGlashan, T. H., Johannessen, J. O., & Vibe-Hansen, L. (1996). First-episode schizophrenia: II. Premorbid patterns by gender. Schizophrenia Bulletin, 22, 257–269.CrossRefGoogle ScholarPubMed
Lemos, S., Vallina, O., Fernandez, P., Ortega, J. A., Garcia, P., Gutierrez, A., et al. (2006). Predictive validity of the Scale of Prodromal Symptoms (SOPS). Actas Espanolas De Psiquiatria, 34, 216–223.Google ScholarPubMed
Lencz, T., Smith, C. W., Auther, A., Correll, C. U., & Cornblatt, B. (2004). Nonspecific and attenuated negative symptoms in patients at clinical high-risk for schizophrenia. Schizophrenia Research, 68, 37–48.CrossRefGoogle ScholarPubMed
Levitt, J. J., O'Donnell, B. F., McCarley, R. W., Nestor, P. G., & Shenton, M. E. (1996). Correlations of premorbid adjustment in schizophrenia with auditory event-related potential and neuropsychological abnormalities. American Journal of Psychiatry, 153, 1347–1349.Google ScholarPubMed
MacBeth, A., & Gumley, A. (2008). Premorbid adjustment, symptom development and quality of life in first episode psychosis: A systematic review and critical reappraisal. Acta Psychiatrica Scandinavica, 117, 85–99.CrossRefGoogle ScholarPubMed
Marder, S. R., Wirshing, W. C., Mintz, J., McKenzie, J., Johnston, K., Eckman, T. A., et al. (1996). Two-year outcome of social skills training and group psychotherapy for outpatients with schizophrenia. American Journal of Psychiatry, 153, 1585–1592.Google ScholarPubMed
Mason, O., Startup, M., Halpin, S., Schall, U., Conrad, A., & Carr, V. (2004). Risk factors for transition to first episode psychosis among individuals with “at-risk mental states.” Schizophrenia Research, 71, 227–237.CrossRefGoogle ScholarPubMed
McGlashan, T., Walsh, B., & Woods, S. W. (2010). The psychosis-risk syndrome: Handbook for diagnosis and follow-up. New York: Oxford University Press.Google Scholar
Miller, T. J., McGlashan, T. H., Rosen, J. L., Cadenhead, K., Cannon, T., Ventura, J., et al. (2003). Prodromal assessment with the structured interview for prodromal syndromes and the Scale of Prodromal Symptoms: Predictive validity, interrater reliability, and training to reliability. Schizophrenia Bulletin, 29, 703–715.CrossRefGoogle ScholarPubMed
Miller, T. J., McGlashan, T. H., Rosen, J. L., Somjee, L., Markovich, P. J., Stein, K., et al. (2002). Prospective diagnosis of the initial prodrome for schizophrenia based on the Structured Interview for Prodromal Syndromes: Preliminary evidence of interrater reliability and predictive validity. American Journal of Psychiatry, 159, 863–865.CrossRefGoogle ScholarPubMed
Monte, R. C., Goulding, S. M., & Compton, M. T. (2008). Premorbid functioning of patients with first-episode nonaffective psychosis: A comparison of deterioration in academic and social performance, and clinical correlates of Premorbid Adjustment Scale scores. Schizophrenia Research, 104, 206–213.CrossRefGoogle ScholarPubMed
Norman, R. M. G., Malla, A. K., Manchanda, R., & Townsend, L. (2005). Premorbid adjustment in first episode schizophrenia and schizoaffective disorders: A comparison of social and academic domains. Acta Psychiatrica Scandinavica, 112, 30–39.CrossRefGoogle ScholarPubMed
Picchioni, M. M., Walshe, M., Toulopoulou, T., McDonald, C., Taylor, M., Waters-Metenier, S., et al. (2010). Genetic modeling of childhood social development and personality in twins and siblings with schizophrenia. Psychological Medicine, 40, 1305–1316.CrossRefGoogle ScholarPubMed
Pinkham, A. E., Penn, D. L., Perkins, D. O., Graham, K. A., & Siegel, M. (2007). Emotion perception and social skill over the course of psychosis: A comparison of individuals “at-risk” for psychosis and individuals with early and chronic schizophrenia spectrum illness. Cognitive Neuropsychiatry, 12, 198–212.CrossRefGoogle ScholarPubMed
Piskulic, D., Addington, J., Auther, A., & Cornblatt, B. A. (2011). Using the global functioning social and role scales in a first-episode sample. Early Intervention Psychiatry, 5, 219–223.CrossRefGoogle Scholar
Pukrop, R., Ruhrmann, S., Schultze-Lutter, F., Bechdolf, A., Brockhaus-Dumke, A., & Klosterkotter, J. (2007). Neurocognitive indicators for a conversion to psychosis: Comparison of patients in a potentially initial prodromal state who did or did not convert to a psychosis. Schizophrenia Research, 92, 116–125.CrossRefGoogle Scholar
Roberts, D. L., & Penn, D. L. (2009). Social cognition and interaction training (SCIT) for outpatients with schizophrenia: A preliminary study. Psychiatry Research, 166, 141–147.CrossRefGoogle ScholarPubMed
Ruhrmann, S., Schultze-Lutter, F., Salokangas, R. K. R., Heinimaa, M., Linszen, D., Dingemans, P., et al. (2010). Prediction of psychosis in adolescents and young adults at high risk: Results from the Prospective European Prediction of Psychosis Study. Archives of General Psychiatry, 67, 241–251.CrossRefGoogle Scholar
Rund, B. R., Melle, I., Friis, S., Johannessen, J. O., Larsen, T. K., Midboe, L. J., et al. (2007). The course of neurocognitive functioning in first-episode psychosis and its relation to premorbid adjustment, duration of untreated psychosis, and relapse. Schizophrenia Research, 91, 132–140.CrossRefGoogle ScholarPubMed
Seidman, L. J., Giuliano, A. J., Meyer, E. C., Addington, J., Cadenhead, K. C., Cannon, T. D., et al. (2010). Neuropsychology of the prodrome to psychosis in the NAPLS consortium. Archives of General Psychiatry, 67, 578–588.CrossRefGoogle ScholarPubMed
Shapiro, D. I., Marenco, S., Spoor, E. H., Egan, M. F., Weinberger, D. R., & Gold, J. M. (2009). The Premorbid Adjustment Scale as a measure of developmental compromise in patients with schizophrenia and their healthy siblings. Schizophrenia Research, 112, 136–142.CrossRefGoogle ScholarPubMed
Silverstein, M. L., Mavrolefteros, G., & Turnbull, A. (2003). Premorbid factors in relation to motor, memory, and executive functions deficits in adult schizophrenia. Schizophrenia Research, 61, 271–280.CrossRefGoogle ScholarPubMed
Strous, R. D., Alvir, J. M. J., Robinson, D., Gal, G., Sheitman, B., Chakos, M., et al. (2004). Premorbid functioning in schizophrenia: Relation to baseline symptoms, treatment response, and medication side effects. Schizophrenia Bulletin, 30, 265–278.CrossRefGoogle ScholarPubMed
Tarbox, S. I., Almasy, L., Gur, R. E., Nimgaonkar, V. L., & Pogue-Geile, M. F. (2012). The nature of schizotypy among multigenerational multiplex schizophrenia families. Journal of Abnormal Psychology. Advance online publication.CrossRefGoogle ScholarPubMed
Tarbox, S. I., Brown, L. H., & Haas, G. L. (2011). Premorbid adjustment in affective and non-affective psychosis: A first episode study. Schizophrenia Bulletin, 37(Suppl. 1), 21–22.Google Scholar
Tarbox, S. I., & Pogue-Geile, M. F. (2008). Social functioning in pre-schizophrenia children and adolescents: A systematic review. Psychological Bulletin, 34, 561–583.CrossRefGoogle Scholar
Thompson, A., Nelson, B., & Yung, A. (2011). Predictive validity of clinical variables in the “at risk” for psychosis population: International comparison with results from the North American Prodrome Longitudinal Study. Schizophrenia Research, 126, 51–57.CrossRefGoogle ScholarPubMed
Van Mastrigt, S., & Addington, J. (2002). Assessment of premorbid function in first-episode schizophrenia: Modifications to the Premorbid Adjustment Scale. Journal of Psychiatry and Neuroscience, 27, 92–101.Google Scholar
Velthorst, E., Nieman, D. H., Becker, H. E., van de Fliert, R., Dingemans, P. M., Klaassen, R., et al. (2009). Baseline differences in clinical symptomatology between ultra high risk subjects with and without a transition to psychosis. Schizophrenia Research, 109, 60–65.CrossRefGoogle ScholarPubMed
Walshe, M., Taylor, M., Schulze, K., Bramon, E., Frangou, S., Stahl, D., et al. (2007). Familial liability to schizophrenia and premorbid adjustment. British Journal of Psychiatry, 191, 260–261.CrossRefGoogle ScholarPubMed
Woods, S. W., Addington, J., Cadenhead, K. S., Cannon, T. D., Cornblatt, B. A., Heinssen, R., et al. (2009). Validity of the prodromal risk syndrome for first psychosis: Findings from the North American Prodrome Longitudinal Study. Schizophrenia Bulletin, 35, 894–908.CrossRefGoogle ScholarPubMed
Yung, A. R., McGorry, P. D., McFarlane, C. A., Jackson, H. J., Patton, G. C., & Rakkar, A. (1996). Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin, 22, 283–303.CrossRefGoogle ScholarPubMed
Yung, A. R., Phillips, L. J., Yuen, H. P., Francey, S. M., McFarlane, C. A., Hallgren, M., et al. (2003). Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group. Schizophrenia Research, 60, 21–32.CrossRefGoogle ScholarPubMed
Yung, A. R., Phillips, L. J., Yuen, H. P., & McGorry, P. D. (2004). Risk factors for psychosis in an ultra high-risk group: Psychopathology and clinical features. Schizophrenia Research, 67, 131–142.CrossRefGoogle Scholar
Zimmerman, M., & Coryell, W. (1989). The reliability of personality disorder diagnoses in a non-patient sample. Journal of Personality Disorders, 3, 53–57.CrossRefGoogle Scholar