Psychopathology persists in ultra-high-risk psychosis patients
medwireNews: Patients at ultra-high-risk (UHR) for psychosis frequently have nonpsychotic disorders and often continue to experience attenuated psychotic symptoms, even if they do not transition to clinical psychosis, a study shows.
Nonpsychotic disorders (mood, anxiety or substance use disorders) were present in 90.1% of the 226 UHR patients at baseline. Although these remitted in 26.0% of the patients, 37.5% developed a new disorder during 2 to 14 years of follow-up. Just 7.3% of patients never had a nonpsychotic disorder.
“Clinically, the results suggest the need for at-risk clinics to include nonpsychotic outcomes in their treatment and follow-up plans”, say Ashleigh Lin (Telethon Kids Institute, University of Western Australia, Subiaco) and study co-authors.
At baseline, mood disorders were the most frequent type of nonpsychotic disorder, occurring in 71.4% of patients. In addition, 39.9% had an anxiety disorder and 21.9% had a substance use disorder. Anxiety and substance use were the most common incident disorders, both occurring in about 17% of patients.
“Thus, the ultra-high risk criteria might also represent a useful system for identifying young people at risk for chronic and emerging nonpsychotic disorder, especially since they are already linked with youth mental health services”, the team writes in The American Journal of Psychiatry.
None of the patients developed outright psychosis, yet at follow-up, 28.3% still had attenuated psychotic symptoms at or above the UHR threshold. Nonpsychotic disorders were more frequent in patients with than without psychotic symptoms, at 84.4% versus 66.6%, with the association being significant for mood disorders, but not anxiety or substance use disorders.
There were few predictors of nonpsychotic disorder incidence and remission. Female gender was associated with an increased risk of persistent or recurrent (vs remitted) mood disorder and with incident anxiety (vs no anxiety). The incidence of any disorder rose with increasing baseline score on the Scale for Assessment of Negative Symptoms, while the risk of persistent or recurrent disorders was reduced in patients who met the criteria for brief limited intermittent psychotic symptoms at baseline.
“The lack of strong predictors of nonpsychotic disorder is distinctly different from the prediction of psychotic illness in at-risk samples, where a number of baseline symptoms are consistently shown to predict onset of psychosis”, the researchers observe.
This suggests that psychotic and nonpsychotic disorders may have distinct predictors, they say, “highlighting the need to design studies with a focus on multiple outcomes at inception.”
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By Eleanor McDermid, Senior medwireNews Reporter