title: Course of psychotic symptoms, depression and global functioning in persons at clinical high risk of psychosis: Results of a longitudinal observation study over three years focusing on both converters and non-converters.
abstract: The aim of this study was to test the validity of the CHR state by focusing on the course of psychosis spectrum symptoms, depression and global functioning in converters and non-converters. A total of 188 CHR-positive subjects (60.2% men) aged between 13 and 35years (mean=20.5) at study outset were assessed five times (t0-t4) over a total observation period of 36months. Conversion to manifest psychosis was defined according to ICD-10 criteria for schizophrenia (F20) or brief psychotic disorder (F23). Measures of positive and negative symptoms were assessed with the Structured Interview for Prodromal Syndromes (SIPS), depression with the Calgary Depression Scale (CDS), and global functioning with the Global Assessment of Functioning Scale (GAF). Converters scored higher over time on all SIPS scales apart from grandiosity (Cohen's d: 0.5-0.7; all p<0.001), higher on the CDS (d=0.43, p=0.001) and lower on the GAF (d=0.69, p<0.001) than did non-converters. Positive and negative symptoms as well as depression were most severe at study outset (t0) and then declined sharply following a linear function over the three-year observation period (t1-t4) across groups (all linear contrasts p<0.001). In conclusion, converters showed significantly more psychopathological symptoms and poorer functioning before crossing the diagnostic threshold for manifest psychosis. CHR-subjects who convert to manifest psychosis during follow-up appear to be recovering from illness rather than becoming ill. Major issues involve the poor discrimination of CHR state and psychosis as well as the dichotomous definition of both at-risk and disease states. Further examination in other CHR-samples is warranted.
authors.affiliation: Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland. Electronic address: michaelpascal.hengartner@zhaw.ch.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Hengartner
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland.
authors.forename: Karsten
authors.initials: K
authors.lastname: Heekeren
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland.
authors.forename: Diane
authors.initials: D
authors.lastname: Dvorsky
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Switzerland.
authors.forename: Susanne
authors.initials: S
authors.lastname: Walitza
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Germany; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Theodoridou
mesh_terms: D000293:Adolescent; D000328:Adult; D003863:Depression / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D062706:Prodromal Symptoms; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000150:complications* / Q000175:diagnosis*; D055815:Young Adult
keywords: Clinical high risk; Conversion; Diagnosis; Psychosis; Schizophrenia; Transition