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Psychosocial outcome in patients at clinical high risk of psychosis: a prospective follow-up

Abstract

Purpose  

In patients at clinical high risk (CHR) of psychosis, transition to psychosis has been the focus of recent studies. Their
broader outcome has received less attention. We studied psychosocial state and outcome in CHR patients.

Methods  

In the European Prediction of Psychosis Study, 244 young help-seeking CHR patients were assessed with the Strauss and Carpenter
Prognostic Scale (SCPS) at baseline, and 149 (61.1 %) of them were assessed for the second time at the 18-month follow-up.
The followed patients were classified into poor and good outcome groups.

Results  

Female gender, ever-married/cohabitating relationship, and good working/studying situation were associated with good baseline
SCPS scores. During follow-up, patients’ SCPS scores improved significantly. Good follow-up SCPS scores were predicted by
higher level of education, good working/studying status at baseline, and white ethnicity. One-third of the followed CHR patients
had poor global outcome. Poor working/studying situation and lower level of education were associated with poor global outcome.
Transition to psychosis was associated with baseline, but not with follow-up SCPS scores or with global outcome.

Conclusion  

The majority of CHR patients experience good short-term recovery, but one-third have poor psychosocial outcome. Good working
situation is the major indicator of good outcome, while low level of education and non-white ethnicity seem to be associated
with poor outcome. Transition to psychosis has little effect on psychosocial outcome in CHR patients. In treating CHR patients,
clinicians should focus their attention on a broader outcome, and not only on preventing transition to psychosis.

  • Content Type Journal Article
  • Category Original Paper
  • Pages 1-9
  • DOI 10.1007/s00127-012-0545-2
  • Authors
    • Raimo K. R. Salokangas, Department of Psychiatry, University of Turku, 20520 Turku, Finland
    • Dorien H. Nieman, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
    • Markus Heinimaa, Department of Psychiatry, University of Turku, 20520 Turku, Finland
    • Tanja Svirskis, Department of Psychiatry, University of Helsinki, Helsinki, Finland
    • Sinikka Luutonen, Department of Psychiatry, University of Turku, 20520 Turku, Finland
    • Tiina From, Department of Psychiatry, University of Turku, 20520 Turku, Finland
    • Heinrich Graf von Reventlow, Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, Bochum, Germany
    • Georg Juckel, Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, Bochum, Germany
    • Don Linszen, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
    • Peter Dingemans, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
    • Max Birchwood, School of Psychology, University of Birmingham, Birmingham, UK
    • Paul Patterson, Youthspace, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
    • Frauke Schultze-Lutter, University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
    • Joachim Klosterkötter, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
    • Stephan Ruhrmann, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
    • The EPOS group