Persistence or recurrence of non-psychotic comorbid mental disorders associated with 6-year poor functional outcomes in patients at ultra high risk for psychosis.
Patients at ultra-high risk for psychosis (UHR) are a highly heterogeneous group in terms of clinical and functional outcomes. Several non-psychotic mental disorders co-occur together with the UHR state. Little is known about the impact of non-psychotic comorbid mental disorders on clinical and functional outcomes of UHR patients.



The sample included 154 UHR help-seeking patients (identified with the CAARMS, comprehensive assessment of the at-risk mental state), evaluated at baseline on the Ham-D, Ham-A (Hamilton depression/anxiety rating scale), and PANSS (positive and negative syndrome scale). 74 patients completed the 6-year follow-up assessment (mean=6.19, SD=1.87). Comorbid disorders at follow-up were assessed with the SCID I and II. Global functioning was rated on the global assessment of functioning (GAF) scale.



In the present sample, 6-year risk of psychosis transition was 28.4%. Among non-transitioned UHR patients, 28.3% reported attenuated psychotic symptoms (APS) and 45.3% remained functionally impaired at follow-up (GAF<60). 56.8% patients were affected by at least one comorbid disorder at follow-up. Among UHR patients who presented with some comorbid disorder at baseline, 61.5% had persistent or recurrent course. Incident comorbid disorders emerged in 45.4% of baseline UHR patients. The persistence or recurrence of non-psychotic comorbid mental disorders was associated with poorer global functional outcomes at follow-up.



A substantial proportion of the initial sample was not available for follow-up interviews and some groups in the analyses had small sample size. Predictors of longitudinal outcomes were not explored.



Among UHR patients, persistence or recurrence of non-psychotic comorbid mental disorders, mostly affective disorders, is associated with 6-year poor functional outcomes.
King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Grazia
G
Rutigliano
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.
Lucia
L
Valmaggia
King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Paola
P
Landi
King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
Marianna
M
Frascarelli
King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
Marco
M
Cappucciati
OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.
Victoria
V
Sear
King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
Matteo
M
Rocchetti
King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
Andrea
A
De Micheli
King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom.
Ceri
C
Jones
King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
Erika
E
Palombini
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.
Philip
P
McGuire
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: paolo.fusar-poli@kcl.ac.uk.
Paolo
P
Fusar-Poli
D015897:Comorbidity; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D062706:Prodromal Symptoms; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000453:epidemiology*; D012008:Recurrence; D012307:Risk Factors; D055815:Young Adult
Comorbid; Global functioning; Outcomes; Remission; UHR