Factors contributing to the duration of untreated prodromal positive symptoms in individuals at ultra-high risk for psychosis

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Abstract

Individuals at ultra-high risk (UHR) for psychosis experience a considerable delay before appropriate clinical attention is provided. Therefore, we investigated the correlates of this delay by examining clinical, socio-demographic and neuropsychological contributors to the duration of untreated prodromal positive symptoms (DUPP) in them (n = 73). The slowly progressive mode of functional decline, defined as a small percentage drop in the Global Assessment of Functioning (GAF) score within the past year, and male gender, explained a considerable portion of the DUPP in the multivariate regression model (F = 9.269, p < 0.001). Slower functional decline may be correlated with delayed care during the UHR period.

Introduction

Longer duration of untreated period in individuals at ultra-high risk (UHR) for psychosis has been reported to hinder their functional recovery (Fusar-Poli et al., 2009) and possibly elevate the risk of transition to psychosis (Nelson et al., 2013). Patients who do not convert to psychosis nevertheless remain at an increased risk for psychosis, experiencing significant distress that requires care (Addington et al., 2011), and available interventions can reduce the conversion to psychosis or relieve their distress (Stafford et al., 2013). Therefore, the negative impact of the untreated prodromal period may reflect an unmet clinical need. However, this period received much less attention, compared to the negative influence of the duration of untreated psychosis, or DUP (Penttilä et al., 2014) and its determinants such as a gradual mode of onset (Apeldoorn et al., 2014). To separately investigate the period that requires intervention rather than the entire prodromal period, we measured the “Duration of Untreated Prodromal Positive symptoms (DUPP)”, which we defined as the period from fulfillment of the operational criteria of UHR focused on prodromal positive symptoms until participation in a specialized UHR program. We hypothesized that a slower functional decline would influence the delayed treatment of UHR individuals, along with additional potential contributing variables including demographics and cognitive functioning. Therefore, we investigated the impact of the changing Global Assessment of Functioning (GAF) scores (Hall, 1995) recorded for the time of enrollment, the highest in the past year and the premorbid state, along with that of demographic data and performances in neurocognitive and social cognitive tasks, on the length of DUPP in the UHR participants.

Section snippets

Methods

Participants with available dataset were selected among the 134 help-seeking individuals who provided written informed consent for participation in an ongoing longitudinal prospective cohort study at the Seoul Youth Clinic (SYC) (Lee et al., 2014) from April 2005 until October 2013, according to the following criteria. UHR status was assessed using the Criteria of Psychosis-risk Syndromes (COPS) criteria from the well-validated Structured Interview for Prodromal Syndromes (SIPS) (Miller et al.,

Results

The 73 participants in this study were predominantly male (64.4%), with an average age of 20.79 ± 3.52 years. The mean DUPP was 18.42 ± 16.16 months (ranging from 1 to 60 months, median = 12 months). While males showed a longer DUPP than females (t = 2.872, p = 0.005), other demographic factors indicated no significant correlations with the DUPP (online Table DS1). The GAF drop in the most recent year manifested a significant negative correlation with the DUPP (r =  0.369, p = 0.003, Fig. 1), while symptoms or

Discussion

In the UHR group, the delay in their treatment was negatively correlated with a rapid functional decline measured by the percentage drop in the GAF score within the past year. While research studies pertaining to the length of untreated prodromal psychotic symptoms per se are scarce, the length of our DUPP value was slightly shorter than the duration of ‘at risk’ symptoms (29.29 ± 21.85 months) in a previous study (Fusar-Poli et al., 2009) (n = 49), which also measured a similar construct. The

Role of the funding source

This study was supported by a grant from the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A120476).

Contributors

Myong-Wuk Chon, Tae Young Lee, Sung Nyun Kim and Jun Soo Kwon conceived and designed this study. Myong-Wuk Chon and Cho Rong Lee performed the statistical analysis and interpreted the data. Tae Young Lee, Sung Nyun Kim and Min Jung Huh gave advice in the statistical analysis and the interpretation of the data. Myong-Wuk Chon wrote the draft of the manuscript. Tae Young Lee, Hye Youn Park and Na Young Shin participated in revising the article by giving critical advice. Jun Soo Kwon managed and

Conflict of interest

The authors have no conflict of interest to declare.

Acknowledgment

The authors have no acknowledgements to make.

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  • Deconstructing vulnerability for psychosis: Meta-analysis of environmental risk factors for psychosis in subjects at ultra high-risk

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    Within the UHR population, it has been reported that males are more likely to have poorer baseline functioning [65] and that poorer baseline functioning predicts later transitions in males [66]. The male gender has also been associated with a prolonged duration of untreated UHR symptoms [67], which in turn is associated with higher risk of transition [68]. Additional evidence linking male gender and vulnerability to psychosis in UHR samples comes from meta-analyses suggesting that changes in the proportion of males accessing UHR services may contribute to the declining transition risks observed over the recent years [69].

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