title: Short-term functional outcome and premorbid adjustment in clinical high-risk patients. Results of the EPOS project.
abstract: OBJECTIVE
  In patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their childhood to adolescence premorbid adjustment.
  
  
  METHODS
  In all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganised, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9-month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analysed.
  
  
  RESULTS
  During the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 74% to 37%. Poor premorbid adjustment, single marital status, poor work status, and symptoms were associated with low baseline GAF scores. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model.
  
  
  CONCLUSIONS
  A great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are carried out.
authors: Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland; Psychiatric Clinic, Turku University Central Hospital, Turku, Finland; Turku Psychiatric Clinic, Turku Mental Health Centre, Turku, Finland. Electronic address: raimo.k.r.salokangas@utu.fi.
authors: R K R
authors: RK
authors: Salokangas
authors: Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland.
authors: M
authors: M
authors: Heinimaa
authors: Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland.
authors: T
authors: T
authors: From
authors: Department of Biostatistics, University of Turku, Turku, Finland.
authors: E
authors: E
authors: Löyttyniemi
authors: Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland.
authors: T
authors: T
authors: Ilonen
authors: Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland; Psychiatric Clinic, Turku University Central Hospital, Turku, Finland.
authors: S
authors: S
authors: Luutonen
authors: Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland; Psychiatric Clinic, Turku University Central Hospital, Turku, Finland; Turku Psychiatric Clinic, Turku Mental Health Centre, Turku, Finland.
authors: J
authors: J
authors: Hietala
authors: Department of Psychiatry, University of Helsinki, Helsinki, Finland; Peijas Hospital, Helsinki University Central Hospital, Helsinki, Finland.
authors: T
authors: T
authors: Svirskis
authors: Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, Bochum, Germany.
authors: H G
authors: HG
authors: von Reventlow
authors: Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, Bochum, Germany.
authors: G
authors: G
authors: Juckel
authors: Department of Psychiatry and Psychology, University of Maastricht, Maastricht, Netherlands.
authors: D
authors: D
authors: Linszen
authors: Mediant, Enschede, Netherlands.
authors: P
authors: P
authors: Dingemans
authors: School of Psychology, University of Birmingham, Birmingham, United Kingdom.
authors: M
authors: M
authors: Birchwood
authors: Youthspace - Birmingham & Solihull Mental Health Foundation Trust, Birmingham, United Kingdom.
authors: P
authors: P
authors: Patterson
authors: University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland.
authors: F
authors: F
authors: Schultze-Lutter
authors: Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors: S
authors: S
authors: Ruhrmann
authors: Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors: J
authors: J
authors: Klosterkötter
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D062706:Prodromal Symptoms; D011379:Prognosis; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology*; D012306:Risk; D012559:Schizophrenia / Q000175:diagnosis; D012565:Schizophrenic Psychology; D012917:Social Adjustment; D055815:Young Adult
keywords: Clinical high risk; Functional outcome; Premorbid adjustment