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Childhood maltreatment and transition to psychotic disorder independently predict long-term functioning in young people at ultra-high risk for psychosis

Published online by Cambridge University Press:  13 July 2015

A. R. Yung ,
J. Cotter ,
S. J. Wood ,
P. McGorry ,
A. D. Thompson ,
B. Nelson  and
A. Lin
A. R. Yung*
Affiliation:
Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
J. Cotter
Affiliation:
Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
S. J. Wood
Affiliation:
School of Psychology, University of Birmingham, Birmingham, UK
P. McGorry
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia
A. D. Thompson
Affiliation:
Warwick Medical School, University of Warwick, Coventry, UK
B. Nelson
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia
A. Lin
Affiliation:
Telethon Kids Institute, The University of Western Australia, Subiaco, Australia
*
* Address for correspondence: Professor A. Yung, Institute of Brain, Behaviour and Mental Health, University of Manchester, Room 3.305, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. (Email: alison.yung@manchester.ac.uk)
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Abstract

Background.

Individuals identified as at ultra-high risk (UHR) for psychosis are at risk of poor functional outcome regardless of development of psychotic disorder. Studies examining longitudinal predictors of poor functioning have tended to be small and report only medium-term follow-up data. We sought to examine clinical predictors of functional outcome in a long-term longitudinal study.

Method.

Participants were 268 (152 females, 116 males) individuals identified as UHR 2–14 years previously. A range of clinical and sociodemographic variables were assessed at baseline. Functioning at follow-up was assessed using the Social and Occupational Functioning Assessment Scale (SOFAS).

Results.

Baseline negative symptoms, impaired emotional functioning, disorders of thought content, low functioning, past substance use disorder and history of childhood maltreatment predicted poor functioning at follow-up in univariate analyses. Only childhood maltreatment remained significant in the multivariate analysis (p < 0.001). Transition to psychosis was also significantly associated with poor functioning at long-term follow-up [mean SOFAS score 59.12 (s.d. = 18.54) in the transitioned group compared to 70.89 (s.d. = 14.00) in the non-transitioned group, p < 0.001]. Childhood maltreatment was a significant predictor of poor functioning in both the transitioned and non-transitioned groups.

Conclusions.

Childhood maltreatment and transition to psychotic disorder independently predicted poor long-term functioning. This suggests that it is important to assess history of childhood maltreatment in clinical management of UHR individuals. The finding that transition to psychosis predicts poor long-term functioning strengthens the evidence that the UHR criteria detect a subgroup at risk for schizophrenia.

Keywords

At-risk mental statechildhood traumaclinical high riskprodromepsychosisschizophreniaultra-high risk
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 16 , December 2015 , pp. 3453 - 3465
Copyright
Copyright © Cambridge University Press 2015 

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