title: Prediction of functional outcome in young patients with a recent-onset psychiatric disorder: Beyond the traditional diagnostic classification system.
abstract: A critical research goal is to identify modifiable risk factors leading to functional disabilities in young psychiatric patients. The authors developed a multidimensional trans-diagnostic predictive model of functional outcome in patients with the recent-onset of a psychiatric illness. Baseline clinical, psychosis-risk status, cognitive, neurological-soft-signs measures, and dopamine-related-gene polymorphisms (DRD1-rs4532, COMT-rs165599, and DRD4-rs1800955) were collected in 138 young non-psychotic outpatients. 116 individuals underwent follow-up (mean=2.2years, SD=0.9) examination. A binary logistic model was used to predict low-functioning status at follow-up as defined by a score lower than 65 in the social occupational functioning assessment scale. A total of 54% of patients experiences low functioning at follow-up. Attention, Avolition, and Motor-Coordination subscale were significant predictors of low-functioning with an accuracy of 79.7%. A non-significant trend was found for a dopamine-related-gene polymorphism (DRD1-rs4532). The model was independent of psychotic-risk status, DSM-diagnosis, and psychotic conversion. A trans-diagnostic approach taking into account specific neurocognitive, clinical, and neurological information has the potential to identify those individuals with low-functioning independent of DSM diagnosis or the level of psychosis-risk. Specific early interventions targeting modifiable risk factors and emphasize functional recovery in young psychiatric samples, independent of DSM-diagnosis and psychosis-risk, are essential.
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Italy; Department of Psychiatry, UCSD, La Jolla, CA, United States. Electronic address: amedeomin@gmail.com.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Minichino
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Italy; Department of Psychiatry, UCSD, La Jolla, CA, United States.
authors.forename: Marta
authors.initials: M
authors.lastname: Francesconi
authors.affiliation: Division of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States.
authors.forename: Ricardo E
authors.initials: RE
authors.lastname: Carrión
authors.affiliation: Research Center in Neurobiology, Daniel Bovet (CRiN), Rome, Italy; Department of Psychology, Section of Neuroscience, Sapienza University of Rome, Italy.
authors.forename: Arturo
authors.initials: A
authors.lastname: Bevilacqua
authors.affiliation: Villa Armonia Nuova, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Parisi
authors.affiliation: Casa di Cura Villa Letizia, Rome, Italy.
authors.forename: Santo
authors.initials: S
authors.lastname: Rullo
authors.affiliation: Department of Psychology, University of Turin.
authors.forename: Agata
authors.initials: A
authors.lastname: Ando'
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Biondi
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Delle Chiaie
authors.affiliation: Department of Psychiatry, UCSD, La Jolla, CA, United States.
authors.forename: Kristin
authors.initials: K
authors.lastname: Cadenhead
mesh_terms: D000328:Adult; D002394:Catechol O-Methyltransferase / Q000235:genetics; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000145:classification* / Q000175:diagnosis* / Q000235:genetics / Q000503:physiopathology*; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D017447:Receptors, Dopamine D1 / Q000235:genetics; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: C583260:DRD1 protein, human; D017447:Receptors, Dopamine D1; C588010:COMT protein, human; D002394:Catechol O-Methyltransferase
keywords: Functioning; “CAARMS”; “Genetics”; “Neurocognition”; “Neurological soft signs”; “Ultra high risk”