Publication date: January 2020
Source: Behaviour Research and Therapy, Volume 124
Author(s): Jessica A. Hartmann, Stefanie J. Schmidt, Patrick D. McGorry, Maximus Berger, Gregor E. Berger, Eric Y.H. Chen, Lieuwe de Haan, Ian B. Hickie, Suzie Lavoie, Connie Markulev, Nilufar Mossaheb, Dorien H. Nieman, Merete Nordentoft, Andrea Polari, Anita Riecher-Rössler, Miriam R. Schäfer, Monika Schlögelhofer, Stefan Smesny, Andrew Thompson, Swapna K. Verma
The Ultra-High Risk (UHR) for psychosis group is known to be heterogeneous with diverse outcomes. This study aimed to: 1. Identify subclasses of UHR individuals based on trajectories of symptomatic and functional change over time, 2. Identify predictors of these trajectories.
A sample of 304 UHR individuals participating in the Neurapro trial were followed over an average of 40 months. All participants received cognitive-behavioural case management (CBCM). Symptomatic and functional profiles were investigated using latent class growth analysis. Multinomial regression was employed to investigate predictors of classes.
Identified trajectories showed mostly parallel slopes (i.e. improving symptoms/functioning over time), which were primarily distinct regarding the severity of symptomatology/level of functioning at baseline (i.e. the intercept). Higher symptomatic/lower functioning classes were predicted by higher substance use, older age, female gender, and lower cognitive functioning.
No divergent trajectories were identified as all classes improved over time. This may reflect effective treatment through CBCM, natural illness course, or effective engagement with mental health services. Nonetheless, classes highest in symptoms/lowest in functioning still showed considerable impairment during follow-up, highlighting the need for targeted intervention in these subgroups. The study emphasizes the need for more clinical attention directed towards UHR patients being female or using substances.