Poor outcome associated with symptomatic deterioration among help-seeking individuals at risk for psychosis: a naturalistic follow-up study.
OBJECTIVE
It remains debatable whether early intervention for psychosis is capable of meeting the needs of at-risk subjects. The aims of this study were to describe the actual impact of interventions on subjective difficulties and to explore the factors that may be associated with a poor outcome.


METHODS
Participants were help-seeking outpatients at a university hospital who met the Criteria of Prodromal Syndromes. Changes in the symptoms, subjective experience and current insight were assessed using the Scales of Prodromal Symptoms, the Subjective Well-being under Neuroleptics, and the Scale to Assess Unawareness of Mental Disorder, respectively. Global functioning, social functioning and subjective quality of life were evaluated using the Global Assessment of Functioning Scale, the Social Functioning Scale, and the WHO-Quality of Life 26, respectively. These measures were assessed both at baseline and after 1 year.


RESULTS
Forty-six patients agreed to participate. Of the 27 patients who completed the reassessment at the follow-up point, 13 patients (48%) showed little improvement in their positive/negative symptoms, subjective well-being or awareness of their symptoms. Additionally, less severe negative symptoms, more severe general symptoms and lower subjective well-being at baseline significantly predicted a deterioration of positive/negative symptoms after 1 year.


CONCLUSIONS
Our findings suggest that the current strategy for reducing psychosis risk based on positive symptoms should be reappraised.
Department of Neuropsychiatry, School of Medicine, Toho University, Tokyo, Japan.
Keiko
K
Morita
Hiroyuki
H
Kobayashi
Kiyoaki
K
Takeshi
Naohisa
N
Tsujino
Takahiro
T
Nemoto
Masafumi
M
Mizuno
D000293:Adolescent; D000328:Adult; D004198:Disease Susceptibility; D061345:Early Medical Intervention; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D062706:Prodromal Symptoms; D011613:Psychotherapy; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy; D011619:Psychotropic Drugs / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
D011619:Psychotropic Drugs
at-risk mental states; early intervention; prodrome; psychosis; quality of life