title: Predictors of functional outcome in individuals at high clinical risk for psychosis at six years follow-up.
abstract: BACKGROUND
  The long-term functional status of subjects at ultra high risk for psychosis (HR) is relatively under investigated. This study explores baseline predictors of long-term functional outcome in HR subjects who did not convert to psychosis during a 6 years follow-up period.
  
  
  METHODS
  A total of 154 HR were followed up for an average of 6 years. The primary outcome variable was global assessment of functioning at the last follow-up visit as assessed with the Global Assessment of Functioning tool. A multinomial logistic regression was performed to identify potential predictors of functional outcome.
  
  
  RESULTS
  Baseline and follow-up data on functioning was available for 92 HR. Twenty-four (43%) individuals who did not convert to psychosis reported poor functioning at follow-up. Baseline scores in the GAF (Exp(b) = 0.857; 95% CIs: 0.75/0.97), employment status (Exp(b) = 0.029; 95% CIs: 0.00/0.268), and CAARMS total scores (Exp(b) = 1.976; 95% CIs: 1.00/1.14) predicted functional outcome in HR subjects at 6 years.
  
  
  CONCLUSIONS
  Despite the preventive treatments received, many individuals who did not convert to full-blown psychosis in the longer term do not functionally remit. These individuals are lower functioning, unemployed and have higher symptom loading at the time of their presentation to the prodromal clinic. Our study suggests the need for innovative treatments targeting long term functional status beyond the prevention of psychosis onset in the HR population.
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, via di Grottarossa 1035, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Brandizzi
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; OASIS Team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom. Electronic address: lucia.valmaggia@kcl.ac.uk.
authors.forename: L
authors.initials: L
authors.lastname: Valmaggia
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Byrne
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Jones
authors.affiliation: OASIS Team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Iwegbu
authors.affiliation: OASIS Team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Badger
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; OASIS Team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: McGuire
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; OASIS Team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: Fusar-Poli
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D018450:Disease Progression; D004651:Employment; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D062706:Prodromal Symptoms; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D055815:Young Adult
keywords: Functioning; Outcome; Prodromal; Psychosis; Remission; Schizophrenia; Ultra high risk