title: Prefrontal function at presentation directly related to clinical outcome in people at ultrahigh risk of psychosis.
abstract: BACKGROUND
  The prodromal phase of psychosis is characterized by impaired executive function and altered prefrontal activation. The extent to which the severity of these deficits at presentation predicts subsequent clinical outcomes is unclear.
  
  
  METHODS
  We employed functional magnetic resonance imaging in a cohort of subjects at clinical risk for psychosis and in healthy controls. Images were acquired at clinical presentation and again after 1 year, using a 1.5-T Signa MRI scanner while subjects were performing a verbal fluency task. SPM5 was used for the analysis of imaging data. Psychopathological assessment of the "at-risk" symptoms was performed by using the Comprehensive Assessment for the At-Risk Mental State (CAARMS) and the Positive and Negative Symptom Scale (PANSS).
  
  
  RESULTS
  In the at-risk mental state (ARMS) group, between presentation and follow-up, the CAARMS (perceptual disorder and thought disorder subscales) and the PANSS general scores decreased, while the Global Assessment of Functioning (GAF) score increased. Both the ARMS and control groups performed the verbal fluency task with a high degree of accuracy. The ARMS group showed greater activation in the left inferior frontal gyrus but less activation in the anterior cingulate gyrus than controls. Within the ARMS group, the longitudinal normalization of neurofunctional response in the left inferior frontal gyrus was positively correlated with the improvement in severity of hallucination-like experiences.
  
  
  CONCLUSIONS
  The normalization of the abnormal prefrontal response during executive functioning is associated with 12-month psychopathological improvement of prodromal symptoms.
authors: Section of Psychiatry, Department of Health Sciences, University of Pavia, Pavia, Italy. p.fusar@libero.it
authors: P
authors: P
authors: Fusar-Poli
authors: M R
authors: MR
authors: Broome
authors: P
authors: P
authors: Matthiasson
authors: J B
authors: JB
authors: Woolley
authors: A
authors: A
authors: Mechelli
authors: L C
authors: LC
authors: Johns
authors: P
authors: P
authors: Tabraham
authors: E
authors: E
authors: Bramon
authors: L
authors: L
authors: Valmaggia
authors: S C
authors: SC
authors: Williams
authors: P
authors: P
authors: McGuire
mesh_terms: D000328:Adult; D003071:Cognition; D015331:Cohort Studies; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D017397:Prefrontal Cortex / Q000503:physiopathology*; D011618:Psychotic Disorders / Q000503:physiopathology* / Q000523:psychology; D012307:Risk Factors; D016896:Treatment Outcome; D014706:Verbal Learning