title: Symptom trajectories and psychosis onset in a clinical high-risk cohort: the relevance of subthreshold thought disorder.
abstract: BACKGROUND
  Prior studies have implicated baseline positive and negative symptoms as predictors of psychosis onset among individuals at clinical high risk (CHR), but none have evaluated latent trajectories of symptoms over time. This study evaluated the dynamic evolution of symptoms leading to psychosis onset in a CHR cohort.
  
  
  METHODS
  100 CHR participants were assessed quarterly for up to 2.5 years. Latent trajectory analysis was used to identify patterns of symptom change. Logistic and proportional hazards models were employed to evaluate the predictive value for psychosis onset of baseline symptoms and symptom trajectories.
  
  
  RESULTS
  Transition rate to psychosis was 26%. Disorganized communication (i.e., subthreshold thought disorder) presented an increased hazard for psychosis onset, both at baseline (Hazard Ratio (95% CI)=1.4 (1.1-1.9)) and as a trajectory of high persistent disorganized communication (Hazard Ratio (95% CI)=2.2 (1.0-4.9)). Interval clinical data did not improve the predictive value of baseline symptoms for psychosis onset.
  
  
  CONCLUSIONS
  High baseline disorganized communication evident at ascertainment tended to persist and lead to psychosis onset, consistent with prior behavioral and speech analysis studies in similar cohorts. Remediation of language dysfunction therefore may be a candidate strategy for preventive intervention.
authors.affiliation: New York State Psychiatric Institute at Columbia University, 1051 Riverside Drive, New York, NY, USA; Columbia University School of Social Work, New York, NY, USA. Electronic address: jdevylder@ssw.umaryland.edu.
authors.forename: Jordan E
authors.initials: JE
authors.lastname: DeVylder
authors.affiliation: Columbia University School of Social Work, New York, NY, USA. Electronic address: Fmm2116@columbia.edu.
authors.forename: Felix M
authors.initials: FM
authors.lastname: Muchomba
authors.affiliation: New York State Psychiatric Institute at Columbia University, 1051 Riverside Drive, New York, NY, USA. Electronic address: Kegill13@gmail.com.
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Gill
authors.affiliation: New York State Psychiatric Institute at Columbia University, 1051 Riverside Drive, New York, NY, USA. Electronic address: shellybendavid@gmail.com.
authors.forename: Shelly
authors.initials: S
authors.lastname: Ben-David
authors.affiliation: Brooklyn College, Department of Psychology, Brooklyn, NY, USA; The Graduate Center of the City University of NY (CUNY), New York, NY USA. Electronic address: DWalder@brooklyn.cuny.edu.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Walder
authors.affiliation: Creedmoor Psychiatric Center, New York Office of Mental Health, New York, NY, USA; NYU Department of Psychiatry, New York, NY, USA. Electronic address: Dolores.malaspina@nyumc.org.
authors.forename: Dolores
authors.initials: D
authors.lastname: Malaspina
authors.affiliation: New York State Psychiatric Institute at Columbia University, 1051 Riverside Drive, New York, NY, USA. Electronic address: corcora@nyspi.columbia.edu.
authors.forename: Cheryl M
authors.initials: CM
authors.lastname: Corcoran
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003147:Communication Disorders / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000503:physiopathology*; D012372:ROC Curve; D013223:Statistics as Topic; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
keywords: Clinical high risk; Disorganized communication; Latent trajectory analysis; Longitudinal; Schizophrenia; Ultra high risk