Functional Capacity Assessed by the Map Task in Individuals at Clinical High-Risk for Psychosis.
Recent studies have recognized that signs of functional disability in schizophrenia are evident in early phases of the disorder, and, as a result, can potentially serve as vulnerability markers of future illness. However, functional measures in the psychosis prodrome have focused exclusively on real-world achievements, rather than on the skills required to carry-out a particular real-world function (ie, capacity). Despite growing evidence that diminished capacity is critical to the etiology of the established disorder, virtually no attention has been directed towards assessing functional capacity in the pre-illness stages. In the present study, we introduce the Map task, a measure to assess functional capacity in adolescent and young-adult high-risk populations.



The Map task was administered to 609 subjects at Clinical High-Risk (CHR) for psychosis and 242 Healthy Controls (HCs) participating in the North American Prodrome Longitudinal Study (NAPLS2). Subjects were required to efficiently complete a set of specified errands in a fictional town.



CHR participants showed large impairments across major indices of the Map task, relative to the HCs. Most importantly, poor performance on the Map task significantly predicted conversion to psychosis, even after adjusting for age, IQ, clinical state, and other potential confounders.



To the best of our knowledge, the Map task is one of the first laboratory-based measures to assess functional capacity in high-risk populations. Functional capacity deficits prior to the onset of psychosis may reflect a basic mechanism that underlies risk for psychosis. Early intervention targeting this domain may help to offset risk and independently improve long-term outcome.
Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY; Dmclaugh@northwell.edu.
Danielle
D
McLaughlin
Ricardo E
RE
Carrión
Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY; Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY;
Andrea M
AM
Auther
Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY;
Doreen M
DM
Olvet
Department of Psychiatry, University of Calgary, Calgary, AB, Canada;
Jean
J
Addington
Semel Institute for Neuroscience and Human Behavior and Department of Psychology, University of California, Los Angeles, Los Angeles, CA;
Carrie E
CE
Bearden
Department of Psychiatry, University of California, San Diego, La Jolla, CA;
Kristin S
KS
Cadenhead
Department of Psychology, Yale University, School of Medicine, New Haven, CT; Department of Psychiatry, Yale University, School of Medicine, New Haven, CT;
Tyrone D
TD
Cannon
Division of Treatment and Prevention Research, National Institute of Mental Health, Rockville, MD;
Robert K
RK
Heinssen
Department of Psychiatry, University of California, San Francisco, CA;
Daniel H
DH
Mathalon
Department of Psychiatry, Yale University, School of Medicine, New Haven, CT;
Thomas H
TH
McGlashan
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC;
Diana O
DO
Perkins
Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA;
Larry J
LJ
Seidman
Department of Psychiatry, University of California, San Diego, La Jolla, CA; Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA;
Ming T
MT
Tsuang
Department of Psychology, Emory University, Atlanta, GA;
Elaine F
EF
Walker
Department of Psychiatry, Yale University, School of Medicine, New Haven, CT;
Scott W
SW
Woods
Terry E
TE
Goldberg
Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL; Research Service, Bruce W. Carter VA Medical Center, Miami, FL;
Philip D
PD
Harvey
Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY;
Barbara A
BA
Cornblatt
D000293:Adolescent; D000328:Adult; D018450:Disease Progression; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D062706:Prodromal Symptoms; D011618:Psychotic Disorders / Q000503:physiopathology*; D012306:Risk; D055815:Young Adult
CHR; NAPLS; disability; prediction; prodromal; role functioning