title: Childhood maltreatment and transition to psychotic disorder independently predict long-term functioning in young people at ultra-high risk for psychosis.
abstract: BACKGROUND
  Individuals identified as at ultra-high risk (UHR) for psychosis are at risk of poor functional outcome regardless of development of psychotic disorder. Studies examining longitudinal predictors of poor functioning have tended to be small and report only medium-term follow-up data. We sought to examine clinical predictors of functional outcome in a long-term longitudinal study.
  
  
  METHODS
  Participants were 268 (152 females, 116 males) individuals identified as UHR 2-14 years previously. A range of clinical and sociodemographic variables were assessed at baseline. Functioning at follow-up was assessed using the Social and Occupational Functioning Assessment Scale (SOFAS).
  
  
  RESULTS
  Baseline negative symptoms, impaired emotional functioning, disorders of thought content, low functioning, past substance use disorder and history of childhood maltreatment predicted poor functioning at follow-up in univariate analyses. Only childhood maltreatment remained significant in the multivariate analysis (p < 0.001). Transition to psychosis was also significantly associated with poor functioning at long-term follow-up [mean SOFAS score 59.12 (s.d. = 18.54) in the transitioned group compared to 70.89 (s.d. = 14.00) in the non-transitioned group, p < 0.001]. Childhood maltreatment was a significant predictor of poor functioning in both the transitioned and non-transitioned groups.
  
  
  CONCLUSIONS
  Childhood maltreatment and transition to psychotic disorder independently predicted poor long-term functioning. This suggests that it is important to assess history of childhood maltreatment in clinical management of UHR individuals. The finding that transition to psychosis predicts poor long-term functioning strengthens the evidence that the UHR criteria detect a subgroup at risk for schizophrenia.
authors.affiliation: Institute of Brain,Behaviour and Mental Health,University of Manchester,Manchester,UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Yung
authors.affiliation: Institute of Brain,Behaviour and Mental Health,University of Manchester,Manchester,UK.
authors.forename: J
authors.initials: J
authors.lastname: Cotter
authors.affiliation: School of Psychology,University of Birmingham,Birmingham,UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Wood
authors.affiliation: Orygen,The National Centre of Excellence in Youth Mental Health,University of Melbourne,Melbourne,Australia.
authors.forename: P
authors.initials: P
authors.lastname: McGorry
authors.affiliation: Warwick Medical School,University of Warwick,Coventry,UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Thompson
authors.affiliation: Orygen,The National Centre of Excellence in Youth Mental Health,University of Melbourne,Melbourne,Australia.
authors.forename: B
authors.initials: B
authors.lastname: Nelson
authors.affiliation: Telethon Kids Institute,The University of Western Australia,Subiaco,Australia.
authors.forename: A
authors.initials: A
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000069586:Adult Survivors of Child Adverse Events / Q000523:psychology*; D001007:Anxiety / Q000175:diagnosis*; D003071:Cognition; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D018570:Risk Assessment; D012559:Schizophrenia / Q000175:diagnosis*; D055815:Young Adult
keywords: At-risk mental state; childhood trauma; clinical high risk; prodrome; psychosis; schizophrenia; ultra-high risk