Social disability may predict psychosis in at-risk patients
MedWire News: Certain measures of social disability may predict the development of psychosis in at-risk individuals, researchers have found.
"Psychotic disorders are associated with multiple social disabilities in work, study, independent living, interpersonal relations and self-care, and serious disability in functioning is one of the core features of the DSM-IV diagnosis of schizophrenia," explain Don Linszen (University of Amsterdam, The Netherlands) and team.
To investigate whether baseline measures of social disability can be used to predict the transition to psychosis in at-risk individuals, the researchers studied data on 245 help-seeking individuals, aged 16-35 years, with early signs of psychosis who participated in the European Prediction of Psychosis Study.
At baseline, all of the participants completed the Disability Assessment Schedule of the World Health Organization (WHODAS-II), which covers six domains: understanding of and interaction with the world; moving and getting around; self-care; getting along with people; life activities; and participation in society.
Over the 18-month follow-up period, 37 patients made the transition to full-blown psychosis.
The researchers found that patients in the transition group had significantly poorer baseline ratings in domain four (getting along with people) of the WHODAS-II than those who did not progress to full-blown psychosis. This was mainly caused by greater difficulties on the items "making new friends," "maintaining a friendship," and "dealing with people you do not know."
In Cox regression analysis that included use of antipsychotics and antidepressants, baseline difficulties in getting along with people were significantly associated with an increased risk for psychosis transition during follow-up, at a hazard ratio of 1.77.
Linszen and team conclude in the British Journal of Psychiatry: "Our study gives further evidence that a decline in social functioning may be a risk factor for a first psychosis within samples clinically at high risk."
They add: "In combination with other predictors (neurobiological or psychopathological parameters), social disability measures may make a valuable contribution to a more accurate prediction of first psychotic episodes."
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By Mark Cowen