Neurocognitive indicators for a conversion to psychosis: comparison of patients in a potentially initial prodromal state who did or did not convert to a psychosis

Different vulnerability indicators for psychosis and their neuropsychological characteristics in the Northern Finland 1986 Birth Cohort

This study is one of very few that has investigated the neuropsychological functioning of both familial and clinical high risk subjects for psychosis. Participants (N = 164) were members of the Northern Finland 1986 Birth Cohort in the following four groups: familial risk for psychosis (n = 62), clinical risk for psychosis (n = 20), psychosis (n = 13), and control subjects (n = 69). The neurocognitive performance of these groups was compared across 19 cognitive variables. The two risk groups did not differ significantly from controls, but differed from the psychosis group in fine motor function. Neuropsychological impairments were not evident in a non-help-seeking high-risk sample.

Altered prefrontal and hippocampal function during verbal encoding and recognition in people with prodromal symptoms of psychosis

Despite robust evidence of hippocampal abnormalities in schizophrenia, it is unclear whether hippocampal dysfunction predates the onset of psychosis. We used functional magnetic resonance imaging to investigate hippocampal function in subjects with an at-risk mental state (ARMS). Eighteen subjects meeting criteria for an ARMS and 22 healthy controls, matched for age, gender, and premorbid IQ, were scanned while performing a version of the Deese-Roediger-McDermott false memory task. During an encoding phase, subjects read lists of words aloud. Following a delay, they were presented with 24 target words, 24 semantically related lure words, and 24 novel words and required to indicate if each had been presented before. Behaviorally, the ARMS group made more false alarm responses for novel words than controls (P = .04) and had a lower discrimination accuracy for target words (P = .02). During encoding, ARMS subjects showed less activation than healthy controls in the left middle frontal gyrus, the bilateral medial frontal gyri, and the left parahippocampal gyrus. Correct recognition relative to false alarms was associated with differential engagement of the hippocampus bilaterally in healthy controls, but this difference was absent in the ARMS group. The ARMS was associated with altered function in the medial temporal cortex, as well as in the prefrontal regions, during both verbal encoding and recognition. These neurofunctional differences were associated with diminished recognition performance and may reflect the greatly increased risk of psychosis associated with the ARMS.

Neuropsychological profiles in different at-risk states of psychosis: executive control impairment in the early--and additional memory dysfunction in the late--prodromal state

Impairments in neuropsychological functioning have been described in subjects clinically at high risk for psychosis, but the specific cognitive deficits in different clinical high-risk groups remain to be elucidated. The German Research Network on Schizophrenia employs a heuristic 2-stage model: a putatively late prodromal state (LPS), characterized by the onset of attenuated positive or brief psychotic symptoms, and an early prodromal state (EPS), mainly characterized by the presence of basic symptoms, which are predictive for psychosis within the next 10 years. A total of 205 subjects met the criteria for either an EPS or an LPS of psychosis and were assessed with a comprehensive neuropsychological test battery. Neurocognitive profiles of high-risk groups were compared with data of 87 healthy controls comparable with regard to gender, age, and premorbid verbal IQ. Patients in the LPS were impaired in all neurocognitive domains (memory/learning, executive control/processing speed, and working memory) examined, with memory being the worst. Deficits were less pronounced in patients in the EPS, with a specific deficit in the executive control/processing speed domain. Consistent with a progressive neurodevelopmental disorder, some cognitive abilities were already impaired in patients in the EPS, followed by further deterioration in the LPS. Specifically, deficits in executive control functioning were related to the presence of basic symptoms, indicating a vulnerability for psychosis. Memory deficits were associated with the onset of psychotic symptoms indicating further disease progression in the trajectory to psychosis and, thus, may be useful in predicting psychosis and targeting early intervention.

White matter alterations related to P300 abnormalities in individuals at high risk for psychosis: an MRI-EEG study

BACKGROUND

Psychosis onset is characterized by white matter and electrophysiologic abnormalities. The relation between these factors in the development of illness is almost unknown. We studied the relation between white matter volumes and P300 in prodromal psychosis.

METHODS

We assessed white matter volume (detected using magnetic resonance imaging) and electrophysiologic response during an oddball task (P300) in healthy controls and individuals at high clinical risk for psychosis (with an "at-risk mental state" [ARMS]).

RESULTS

We included 41 controls and 39 patients with an ARMS in our study. A psychotic disorder developed in 26% of the ARMS group within the follow-up period of 2 years. The P300 amplitude was significantly lower in the ARMS group than in the control group. The ARMS group showed reduced volume of white matter underlying the left superior temporal gyrus and the left superior frontal gyrus and increased volume of white matter underlying the right insula and the right angular gyrus compared with controls. Relative to individuals who did not later become psychotic, the subgroup in whom psychosis subsequently developed had a smaller volume of white matter underlying the left precuneus and the right middle temporal gyrus and increased volume in the white matter underlying the right middle frontal gyrus. We observed a significant interaction in the right middle frontal gyrus: white matter volume was negatively associated with P300 amplitude in the ARMS group and positively associated with P300 amplitude in the control group.

LIMITATIONS

The voxel-based morphometry method alone cannot determine whether abnormal white matter volumes are due to an altered number of axonal connections or decreased myelination.

CONCLUSION

P300 abnormalities precede the onset of psychosis and are directly related to white matter alterations, representing a correlate of an increased vulnerability to disease.

Neuroanatomic predictors to prodromal psychosis in velocardiofacial syndrome (22q11.2 deletion syndrome): a longitudinal study

BACKGROUND

Up to 30% of young adults with velocardiofacial syndrome (VCFS; 22q11.2 deletion syndrome) develop schizophrenia or psychosis. Identifying the neuroanatomic trajectories that increase risk for psychosis in youth with this genetic disorder is of great interest.

METHODS

We acquired high-resolution anatomic magnetic resonance images and measures of psychiatric function on 72 youth with VCFS, 26 unaffected siblings, and 24 age-matched community control subjects at two time points: between late childhood (mean age 11.9 years) and mid-adolescence (mean age 15.1 years).

RESULTS

With the exception of cranial gray matter and orbitofrontal prefrontal cortex, neuroanatomic trajectories in youth with VCFS were comparable to unaffected siblings and community control subjects during this developmental window. However, in youth with VCFS, longitudinal decreases in the volumes of cranial gray and white matter, prefrontal cortex, mesial temporal lobe, and cerebellum were associated with increased combined prodromal symptoms at Time 2. In contrast, only decreases in temporal lobe gray matter volumes (p < .002) and verbal IQ (p < .002) predicted specifically to positive prodromal symptoms of psychosis at Time 2.

CONCLUSIONS

These findings are in line with studies of non-VCFS individuals at risk for schizophrenia and suggest that early decrements in temporal lobe gray matter may be predictive of increased risk of prodromal psychotic symptoms in youth with VCFS.

[Brain imaging and transition to psychosis]

First episode psychosis is usually preceded by a prodromal period of about 5 years during which the manifestation of the disease is not yet clear. This prodromal phase is called 'At Risk Mental State' (ARMS) as all subjects with prodromal symptoms will not develop a psychotic disorder. Several brain imaging studies have been conducted over the past decade in these ARMS subjects and found structural, functional and neurochemical deviations. These deviations are similar to those observed when the psychosis is established but with less severity. These deviations have important translational perspective as they might help to distinguish the development of a psychotic disorder from occasional psychotic symptoms.

Altered brain function directly related to structural abnormalities in people at ultra high risk of psychosis: longitudinal VBM-fMRI study

BACKGROUND

Several studies have indicated that people with prodromal signs of psychosis show alterations in the structure and function of the brain when they first present to clinical services. However, the longitudinal course of these abnormalities, and how they relate to subsequent clinical and functional outcome is relatively unclear.

METHODS

A cohort of subjects at ultra high risk of psychosis were studied using functional magnetic resonance imaging (fMRI) in conjunction with the N-Back task, and volumetric MRI at first clinical presentation and again after one year. Levels of psychopathology and global functioning were assessed at the same time points using the CAARMS, PANSS, and the GAF scale.

RESULTS

At baseline, the high risk group showed reduced activation during the task in the left middle frontal gyrus, supramarginal gyrus and inferior parietal lobule, and reduced gray matter volume in the left middle and medial frontal gyri, left insula and the right anterior cingulate gyrus. Within the high-risk group, there was a positive correlation between the magnitude of the functional and structural alterations in the left middle frontal gyrus. Between presentation and follow up, the severity of perceptual disorder and thought disorder (rated by the CAARMS), and of general psychopathology (rated by the PANSS general score) decreased, and the level of global functioning improved. This clinical and functional improvement was associated with a longitudinal increase in activation in the anterior cingulate and right parahippocampal gyrus. The change in anterior cingulate response was directly correlated with the improvement in the GAF score.

CONCLUSIONS

In subjects presenting with prodromal signs of psychosis, reduced prefrontal activation during a working memory task is associated with a reduction in gray matter volume in the same area. Changes in anterior cingulate activation were correlated with functional improvement in this group, consistent with the role of this region in multiple cognitive and social processes.

Increased anterior cingulate and temporal lobe activity during visuospatial working memory in children and adolescents with schizophrenia

OBJECTIVE

Similar to adults, children and adolescents with schizophrenia present with significant working memory (WkM) deficits. However, unlike adults, findings of abnormal activity in the prefrontal cortex in early-onset schizophrenia (EOS) are not consistently reported. Since WkM continues to develop through adolescence and into early adulthood, patterns of activation in adolescents may be different than those found in adults. The goal of this study was to evaluate the functional neurobiology of WkM in patients with EOS.

METHOD

Participants included 22 patients with EOS (mean age 15±2.8 years) and 24 controls (mean age 15.0±3.0 years). Diagnoses were confirmed using the KIDDIE-SADS-PL. All subjects underwent a functional MRI paradigm involving a visuospatial working memory task with three separate loads.

RESULTS

The behavioral results demonstrated deficits in EOS patients at all three WkM loads. On functional imaging, EOS patients demonstrated increased activation in the anterior cingulate cortex (ACC), medial temporal lobe structures, the insula, and bilateral lateral temporal lobes.

CONCLUSIONS

Patients with EOS demonstrate increased activity in limbic structures and regions involved in processing primary and secondary sensory information. In addition, EOS patients had load dependent decreased activity in the parietal lobe. Unlike studies in adults, we did not find that EOS patients had activation differences in the frontal cortical regions. One possibility is that abnormalities in PFC function are related to secondary downstream or developmental processes which are 'unmasked' during development. Finally, our findings support growing evidence that EOS patients have aberrations in the limbic and temporal lobe regions.

Poor functioning ability is associated with high risk of developing psychosis in adolescents

BACKGROUND

While functioning ability, quality of life (QoL) and depression are widely studied phenomena in schizophrenia, little is known about functioning ability, QoL and depression, especially among adolescents at high risk of developing first-episode psychosis.

AIM

To investigate associations between high risk of developing psychosis and functioning ability, depression and QoL among adolescents.

METHODS

The data was collected by an early intervention team in Espoo, Finland, between 1 January 2007 and 31 May 2008. Subjects at high risk of developing psychosis were compared with subjects not at high risk in terms of functioning ability (GAF), QoL (16D) and depressive symptoms (RBDI) in a cross-sectional setting. The study was conducted with 80 adolescents (mean age 14.7, range 12-18 years).

RESULTS

Those at high risk of developing psychosis had significantly lower and poorer scores in functioning ability (53.4 vs. 58.4, P=0.006), had higher and poorer scores in QoL (10.81 vs. 7.05, P=0.002) and higher and poorer scores in depression (8.95 vs. 4.76, P=0.001) than those who did not meet the criteria of being at high risk of developing psychosis. Poorer functioning ability independently explained being at high risk of developing psychosis at a statistically significant level (P=0.021) in a logistic regression analysis after age, gender, depression and QoL were adjusted for.

CONCLUSIONS

Poor functioning ability seems to be associated with high risk of developing psychosis among adolescents.

Cognitive control deficits in schizophrenia: mechanisms and meaning

Although schizophrenia is an illness that has been historically characterized by the presence of positive symptomatology, decades of research highlight the importance of cognitive deficits in this disorder. This review proposes that the theoretical model of cognitive control, which is based on contemporary cognitive neuroscience, provides a unifying theory for the cognitive and neural abnormalities underlying higher cognitive dysfunction in schizophrenia. To support this model, we outline converging evidence from multiple modalities (eg, structural and functional neuroimaging, pharmacological data, and animal models) and samples (eg, clinical high risk, genetic high risk, first episode, and chronic subjects) to emphasize how dysfunction in cognitive control mechanisms supported by the prefrontal cortex contribute to the pathophysiology of higher cognitive deficits in schizophrenia. Our model provides a theoretical link between cellular abnormalities (eg, reductions in dentritic spines, interneuronal dysfunction), functional disturbances in local circuit function (eg, gamma abnormalities), altered inter-regional cortical connectivity, a range of higher cognitive deficits, and symptom presentation (eg, disorganization) in the disorder. Finally, we discuss recent advances in the neuropharmacology of cognition and how they can inform a targeted approach to the development of effective therapies for this disabling aspect of schizophrenia.

Associations between psychotic-like symptoms and inattention/hyperactivity symptoms

OBJECTIVE

Our aim was to study the association between psychotic-like symptoms and inattention/hyperactivity symptoms in a general adolescent population.

SUBJECTS AND METHODS

The sample is based on a population-based prospective mother-child birth cohort, the Northern Finland Birth Cohort 1986. In the 15-16-year follow-up survey, the adolescents completed the Youth Self-Report questionnaire as well as the PROD-Screen questionnaire that addressed prodromal symptoms of psychosis. Meanwhile, their parents assessed inattention and hyperactive symptoms of their offspring by completing the Strengths and Weaknesses of ADHD Symptoms and Normal Behaviors questionnaire (N = 5,318). The cross-sectional associations between psychotic-like symptoms and inattention/hyperactivity symptoms were studied with logistic regression models.

RESULTS

The association between negative psychotic-like symptoms and inattention symptoms, especially the dreamy type of inattention symptoms (e.g., difficulties in organizing tasks, losing things, being forgetful), was statistically significant for both genders. Psychotic-like symptoms, however, were not associated with hyperactivity symptoms.

CONCLUSIONS

The present findings demonstrate that an association between psychotic-like symptoms and attentional dysfunction, which has been found in clinical samples, is also present in a general adolescent population.

Gray matter alterations related to P300 abnormalities in subjects at high risk for psychosis: longitudinal MRI-EEG study

BACKGROUND

Psychotic disorders are characterized by gray matter and volumetric and electrophysiological abnormalities. The relationship between these factors in the onset of psychotic illness is unclear.

METHODS

Eighty English-native right-handed subjects (39 subjects at ultra high risk for psychosis "ARMS" and 41 healthy volunteers) were scanned with MRI, and studied using EEG during an oddball task. Both assessments were performed at first clinical presentation. The ARMS subjects were then followed clinically, with the MRI and EEG assessments repeated in a subgroup of each sample.

RESULTS

The P300 amplitude at presentation was significantly lower in the ARMS subjects than in controls. At baseline, the ARMS group showed reduced gray matter volume relative to controls in the right superior frontal gyrus, left medial frontal gyrus, left inferior frontal gyrus, right orbital gyrus and right supramarginal gyrus. Transition to psychosis (26%) was associated with reduced gray matter in the right inferior parietal lobule and in the left parahippocampal gyrus. Within the ARMS group, there was a positive correlation between P300 amplitude and gray matter volume in the right supramarginal gyrus. A significant group by P300 by gray matter interaction was detected in the left medial frontal gyrus. Longitudinal assessment revealed progressive gray matter alterations in prefrontal and subcortical areas of the ARMS but no significant changes in P300 amplitude over time.

CONCLUSIONS

P300 abnormalities in the ARMS are related to alterations in regional gray matter volume and represent a correlate of an increased vulnerability to psychosis.

Neural correlates of visuospatial working memory in the 'at-risk mental state'

BACKGROUND

Impaired spatial working memory (SWM) is a robust feature of schizophrenia and has been linked to the risk of developing psychosis in people with an at-risk mental state (ARMS). We used functional magnetic resonance imaging (fMRI) to examine the neural substrate of SWM in the ARMS and in patients who had just developed schizophrenia.

METHOD

fMRI was used to study 17 patients with an ARMS, 10 patients with a first episode of psychosis and 15 age-matched healthy comparison subjects. The blood oxygen level-dependent (BOLD) response was measured while subjects performed an object-location paired-associate memory task, with experimental manipulation of mnemonic load.

RESULTS

In all groups, increasing mnemonic load was associated with activation in the medial frontal and medial posterior parietal cortex. Significant between-group differences in activation were evident in a cluster spanning the medial frontal cortex and right precuneus, with the ARMS groups showing less activation than controls but greater activation than first-episode psychosis (FEP) patients. These group differences were more evident at the most demanding levels of the task than at the easy level. In all groups, task performance improved with repetition of the conditions. However, there was a significant group difference in the response of the right precuneus across repeated trials, with an attenuation of activation in controls but increased activation in FEP and little change in the ARMS.

CONCLUSIONS

Abnormal neural activity in the medial frontal cortex and posterior parietal cortex during an SWM task may be a neural correlate of increased vulnerability to psychosis.

Structural brain alterations in individuals at ultra-high risk for psychosis: a review of magnetic resonance imaging studies and future directions

Individuals at ultra-high-risk (UHR) for psychosis have become a major focus for research designed to explore markers for early detection of and clinical intervention in schizophrenia. In particular, structural magnetic resonance imaging studies in UHR individuals have provided important insight into the neurobiological basis of psychosis and have shown the brain changes associated with clinical risk factors. In this review, we describe the structural brain abnormalities in magnetic resonance images in UHR individuals. The current accumulated data demonstrate that abnormalities in the prefrontal and temporal cortex and anterior cingulate cortex occur before illness onset. These regions are compatible with the regions of structural deficits found in schizophrenia and first-episode patients. In addition, the burgeoning evidence suggests that such structural abnormalities are potential markers for the transition to psychosis. However, most findings to date are limited because they are from cross-sectional rather than longitudinal studies. Recently, researchers have emphasized neurodevelopmental considerations with respect to brain structural alterations in UHR individuals. Future studies should be conducted to characterize the differences in the brain developmental trajectory between UHR individuals and healthy controls using a longitudinal design. These new studies should contribute to early detection and management as well as provide more predictive markers of later psychosis.

The case for including Attenuated Psychotic Symptoms Syndrome in DSM-5 as a psychosis risk syndrome

The American Psychiatric Association Task Force on DSM-5 has recently proposed consideration of Attenuated Psychotic Symptoms Syndrome as a new diagnosis, based on nearly 15 years of prospective research in centers across the globe. The condition is also known as "psychosis risk syndrome," "at-risk mental state," "ultra-high risk," and "putative prodrome." We review evidence favoring its inclusion as a new diagnosis in DSM-5 and report new preliminary findings on DSM-IV diagnoses in current clinical use for these patients and on results of diagnostic interviews in unselected volunteers. The main evidence supporting inclusion is: (1) the patients are currently ill, (2) the patients are at high risk for getting worse, (3) no DSM-IV diagnosis accurately captures their current illness or future risk, (4) the diagnosis has been made with reliability and validity in the research setting, and (5) placement in DSM-5 would help promote the needed treatment and prevention research to enable articulation of a standard of care to benefit these patients and their families. Potential harms can be minimized by patient, family, and provider education. It will be important to demonstrate through well-designed field trials whether the diagnostic criteria can be used with reliability in everyday clinical practice.

Neuroanatomical correlates of executive dysfunction in the at-risk mental state for psychosis

Deficits in executive functioning have been described as a core feature of schizophrenia and have been linked to patterns of fronto-temporo-limbic brain alterations. To date, such structure-cognition relationships have not been explored in a clinically defined at-risk mental state (ARMS) for psychosis using whole-brain neuroimaging techniques. Therefore, we used voxel-based morphometry in 40 ARMS and 30 matched healthy control (HC) individuals to investigate whether gray and white matter volumes (1) correlated with the performance in the Trail-Making Test B (TMT-B), an established measure of executive functioning, and (2) were volumetrically linked to the ventromedial prefrontal cortex (VMPFC), found to be associated with TMT-B in the ARMS during the first analysis step. We found the ARMS subjects to be specifically impaired in their TMT-B performance versus HC. Brain-cognition associations involving the insular cortices were observed in the HC, but not in the ARMS individuals. Conversely, TMT-B correlations in the VMPFC, the cerebellum, the fronto-callosal white matter were detected in the ARMS, but not the HC group. The VMPFC was linked to the temporo-limbic cortices in HC, whereas the connectivity pattern in the ARMS involved the left temporal and dorsolateral prefrontal cortex, the cerebellum, the right SMA and extended portions of the fronto-callosal white matter. These findings suggest that executive deficits are already present in the ARMS for psychosis and may be subserved by structurally altered networks of interconnected cortical and subcortical brain regions in line with the disconnectivity hypothesis of schizophrenia.

Verbal and visuospatial working memory development and deficits in children and adolescents with schizophrenia

AIM

Deficits in working memory are considered a core feature of schizophrenia and are present early in the course of the illness. Because working memory continues to mature through childhood and into early adulthood, it was the aim of this study to assess developmental trajectories of verbal and visuospatial working memory performance in children and adolescents with schizophrenia. Differences in the developmental trajectories in patients compared with controls may reflect differential effects within specific neural networks involved in working memory performance.

METHODS

Twenty-six children and adolescents with schizophrenia (age range of 8-19 years) and 37 controls matched on age and gender participated in the study. Modified versions of both a verbal and visuospatial Sternberg Item Recognition Paradigm were administered.

RESULTS

In the three age groups studied, patients performed significantly worse than controls on the verbal working memory tasks. There were significant effects of diagnosis and load on the verbal Sternberg, with patients performing worse than controls. However, there was no diagnosis by load interactions. Similar findings were present for the visuospatial Sternberg, except for the youngest age group. The 8- to 12-year-old patients had a disproportionately lower performance on the verbal working memory task than on the visuospatial task.

CONCLUSIONS

Our findings support disruptions in shared verbal and visuospatial working memory networks, such as those supporting encoding processes, in children and adolescents with schizophrenia. We also found specific deficits in non-shared verbal working memory performance in childhood-onset schizophrenia.

EEG spectral power and negative symptoms in at-risk individuals predict transition to psychosis

INTRODUCTION

EEG power in the delta, theta and beta1 bands has been shown to be positively correlated with negative symptoms in first episode psychotic patients. The present study investigates this correlation in an "at risk mental state for psychosis" (ARMS) with the aim to improve prediction of transition to psychosis.

METHODS

Thirteen ARMS patients with later transition to psychosis (ARMS-T) and fifteen without (follow-up period of at least 4 years) (ARMS-NT) were investigated using spectral resting EEG data (of 8 electrodes over the fronto-central scalp area placed according to the 10-20 system) and summary score of the Scale for the Assessment of Negative Symptoms (SANS). Linear regressions were used to evaluate the correlation of SANS and EEG power in seven bands (delta, theta, alpha1, alpha2, beta1, beta2, beta3) in both ARMS groups and logistic regressions were used to predict transition to psychosis. Potentially confounding factors were controlled.

RESULTS

ARMS-T and ARMS-NT showed differential correlations of EEG power and SANS in delta, theta, and beta1 bands (p<.05): ARMS-T showed positive and ARMS-NT negative correlations. Logistic regressions showed that neither SANS score nor EEG spectral power alone predicted transition to psychosis. However, SANS score in combination with power in the delta, theta, beta1, and beta2 bands, respectively, predicted transition significantly (p<.03).

CONCLUSIONS

ARMS-T and ARMS-NT show differential correlations of SANS summary score and EEG power in delta, theta, and beta bands. Prediction of transition to psychosis is possible using combined information from a negative symptom scale and EEG spectral data.

Neural correlates of movement generation in the 'at-risk mental state'

OBJECTIVE

People with 'prodromal' symptoms have a very high risk of developing psychosis. We examined the neurocognitive basis of this vulnerability by using functional MRI to study subjects with an at-risk mental state (ARMS) while they performed a random movement generation task.

METHOD

Cross-sectional comparison of individuals with an ARMS (n = 17), patients with first episode schizophreniform psychosis (n = 10) and healthy volunteers (n = 15). Subjects were studied using functional MRI while they performed a random movement generation paradigm.

RESULTS

During random movement generation, the ARMS group showed less activation in the left inferior parietal cortex than controls, but greater activation than in the first episode group.

CONCLUSION

The ARMS is associated with abnormalities of regional brain function that are qualitatively similar to those in patients who have recently presented with psychosis but less severe.

Spatial working memory in individuals at high risk for psychosis: longitudinal fMRI study

BACKGROUND

Neurocognitive impairments in executive and mnemonic domains are already evident in the pre-psychotic phases. The longitudinal dynamic course of the neurofunctional abnormalities underlying liability to psychosis and their relation to clinical outcomes is unknown.

METHODS

In this study we used functional magnetic resonance imaging (fMRI) in a cohort of subjects at ultra high clinical risk for psychosis (with an "At Risk Mental State", ARMS) and in healthy controls. Images were acquired at baseline and again after one year on a 1.5 Tesla Signa, while patients were performing a visuospatial working memory task. Psychopathological assessment of the prodromal symptoms was conducted at the same time points by using the CAARMS and the PANSS instruments.

RESULTS

There were no significant differences between the ARMS and control groups with respect to age or IQ. Although both groups performed the PAL task with a high degree of accuracy, the ARMS showed an increased latency in answers during the most demanding level of the task. At baseline, such cognitive impairment was associated with reduced activation in the left precuneus, left superior parietal lobule, right middle temporal gyrus in the ARMS as compared to controls. In addition, the ARMS failed to activate parietal areas with increasing difficulty of the task. Between presentation and follow-up the overall clinical status of the ARMS sample improved, despite 2 out of the 15 subjects having developed a full-blown psychosis: the CAARMS (perceptual disorder and thought disorder subscales) and the PANNS general scores decreased, while the GAF score increased. Such clinical amelioration was associated with a longitudinal compensatory increase in occipitoparietal regions.

CONCLUSIONS

The prodromal phase of psychosis is associated with functional alterations in parietal and temporal networks subserving visuospatial working memory which are more evident under high cognitive loads. The clinical improvement at one year is associated with a compensatory increase in occipitoparietal regions.

Differentiating adolescents at clinical high risk for psychosis from psychotic and non-psychotic patients with the Rorschach

This study was designed to assess cognitive functioning in a clinical sample of adolescents with heterogeneous psychiatric diagnoses, with a specific focus on patients at clinical high risk (CHR) for psychosis. The sample comprised 22 patients identified at CHR for psychosis, 67 psychotic and 187 non-psychotic, non-CHR patients. Neuropsychological assessment was conducted as part of the clinical examination and treatment, including Wechsler Intelligence Scale for Children (WISC)-III and/or Wechsler Adult Intelligence Scale (WAIS)-III measures of verbal comprehension, perceptual organisation, working memory and processing speed, Wisconsin Card Sorting Test (WCST) measures of executive function, and the Rorschach Comprehensive System measures of perceptual and thinking accuracy. Patients at CHR for psychosis did not significantly differ from other patient groups in terms of intellectual or executive functions. The Rorschach Perceptual Thinking Index (PTI) distinguished patients at CHR for psychosis from those diagnosed as having non-psychotic disorders, but not from those diagnosed as psychotic. Our results suggest perceptual and thought disturbance as an important indicator of vulnerability to psychosis.

Impaired verbal self-monitoring in individuals at high risk of psychosis

BACKGROUND

Cognitive models suggest that auditory verbal hallucinations arise through defective self-monitoring and the external attribution of inner speech. We used a paradigm that engages verbal self-monitoring (VSM) to examine whether this process is impaired in people experiencing prodromal symptoms, who have a very high risk of developing psychosis.

METHOD

We tested 31 individuals with an At-Risk Mental State (ARMS) and 31 healthy volunteers. Participants read single adjectives aloud while the source and pitch of the online auditory verbal feedback was manipulated, then immediately identified the source of the speech they heard (Self/Other/Unsure). Response choice and reaction time were recorded.

RESULTS

When reading aloud with distorted feedback of their own voice, ARMS participants made more errors than controls (misidentifications and unsure responses). ARMS participants misidentified the source of their speech as 'Other' when the level of acoustic distortion was severe, and misidentification errors were inversely related to reaction times.

CONCLUSIONS

Impaired VSM is evident in people with an ARMS, although the deficit seems to be less marked than in patients with schizophrenia. Follow-up of these participants may clarify the extent to which the severity of this impairment predicts the subsequent onset of psychosis and development of positive symptoms.

Neuropsychology of the prodrome to psychosis in the NAPLS consortium: relationship to family history and conversion to psychosis

CONTEXT

Early detection and prospective evaluation of clinical high-risk (CHR) individuals who may develop schizophrenia or other psychotic disorders is critical for predicting psychosis onset and for testing preventive interventions.

OBJECTIVES

To elucidate the neuropsychology of the CHR syndrome, to determine the association of neuropsychological function with conversion to psychosis and family history of psychosis, and to examine whether baseline neuropsychological functioning predicts subsequent psychosis.

DESIGN

Longitudinal study with 2(1/2) years of follow-up.

SETTING

Eight centers participating in the North American Prodrome Longitudinal Study.

PARTICIPANTS

Three hundred four prospectively identified CHR individuals meeting Structured Interview for Prodromal Syndromes criteria, 52 non-CHR persons with a family history of psychosis in first- or second-degree relatives (family high-risk group), and 193 normal controls with neither a family history of psychosis nor a CHR syndrome, all of whom underwent baseline neuropsychological evaluations.

MAIN OUTCOME MEASURES

A neurocognitive composite score, 8 individual neuropsychological measures, an IQ estimate, and high-risk status.

RESULTS

Global ("composite") neuropsychological functioning was comparably impaired in the CHR and family high-risk groups compared with controls, but profiles differed significantly between groups. Neuropsychological functioning in the CHR group was significantly lower in persons who progressed to psychosis than in those who did not and was worst in the subgroup with a family history of psychosis. Tests of processing speed and verbal learning and memory were most sensitive in discriminating CHR individuals from controls, although reductions were less severe than in established schizophrenia. Neuropsychological functioning did not contribute uniquely to the prediction of psychosis beyond clinical criteria, but worse verbal memory predicted more rapid conversion.

CONCLUSIONS

These findings document that CHR individuals have significant neuropsychological difficulties, particularly those who later develop psychosis. This dysfunction is generally of moderate severity but less than in first-episode schizophrenia, suggesting that further decline may occur after baseline CHR assessment.

Neurocognitive indicators of clinical high-risk states for psychosis: a critical review of the evidence

The present review investigates the empirical evidence from cross-sectional and long-term follow-up studies on neurocognitive indicators of an increased risk for developing schizophrenia spectrum psychoses in clinically defined high-risk samples. First, the investigations at the Cologne center for early recognition and intervention are briefly summarized and then integrated within the available literature. Thirty-two studies with original data could be identified by extensive literature search. Cross-sectional investigations of neurocognitive baseline assessments in high-risk samples with unknown conversion status have produced rather inconsistent results. Nevertheless, most convincing evidence could be collected for abnormal functioning in processing speed measures (digit symbol coding, Trailmaking Test-B, Stroop Color Naming), the Continuous Performance Test, verbal working memory measures, verbal memory and learning, and verbal fluency, though negative findings have also been reported in every instance. Moreover, high-risk subjects were found to perform both at the schizophrenia performance level and at a close to normal level. Longitudinal follow-up assessments provided predictive evidence with regard to psychosis conversion for measures of processing speed and of verbal memory and learning. However, a substantial number of negative findings does not allow for straight-forward conclusions. Finally, some reasons for inconsistent findings are discussed critically speculating on demographic differences, reliability and sample sizes, and conceptual imprecision in communicating results.

Research in people with psychosis risk syndrome: a review of the current evidence and future directions

After decades of research, schizophrenia and related psychotic disorders are still among the most debilitating disorders in medicine. The chronic illness course in most individuals, greater treatment responsiveness during the first episode, progressive gray matter decline during early disease stages, and retrospective accounts of 'prodromal' or early illness signs and symptoms formed the basis for research on the psychosis risk syndrome (PRS), known variably as 'clinical high risk' (CHR), or 'ultra-high risk' (UHR), or 'prodromal'. The pioneering era of research on PRS focused on the development and validation of specific assessment tools and the delineation of high risk criteria. This was followed by the examination of conversion rates in psychosis risk cohorts followed naturalistically, identification of predictors of conversion to psychosis, and investigation of interventions able to abort or delay the development of full psychosis. Despite initially encouraging results concerning the predictive validity of PRS criteria, recent findings of declining conversion rates demonstrate the need for further investigations. Results from intervention studies, mostly involving second-generation antipsychotics and cognitive behavioral therapy, are encouraging, but are currently still insufficient to make treatment recommendations for this early, relatively non-specific illness phase. The next phase of research on PRS, just now beginning, has moved to larger, 'multisite' projects to increase generalizability and to ensure that sufficiently large samples at true risk for psychosis are included. Emphasis in these emerging studies is on: 1) identification of biomarkers for conversion to psychosis; 2) examination of non-antipsychotic, neuroprotective and low-risk pharmacologic and non-pharmacologic interventions; 3) testing of potentially phase-specific interventions; 4) examination of the relationship between treatment response during PRS and prognosis for the course of illness; 5) follow-up of patients who developed schizophrenia despite early interventions and comparison of illness trajectories with patients who did not receive early interventions; 6) characterization of individuals with outcomes other than schizophrenia-spectrum disorders, such as bipolar disorder and remission from PRS, including false positive cases; and 7) assessment of meaningful social and role functioning outcomes. While the research conducted to date has already yielded crucial information, the translation of the concept of a clinically identifiable PRS into clinical practice does not seem justified at this point.

Course of neurocognitive deficits in the prodrome and first episode of schizophrenia

Understanding the trajectory of cognitive changes in the development of schizophrenia may shed light on the neurodevelopmental processes in the beginning stage of illness. Subjects at risk for psychosis (AR, n = 48), patients in their first episode of schizophrenia (FE, n = 20), and normal comparison subjects (n = 29) were assessed on a neurocognitive battery at baseline and at a 6-month follow-up. There were significant group differences across all cognitive domains as well as a significant group by time interaction in the verbal learning domain. After statistically controlling for practice effects and regression to the mean, a high proportion of FE subjects showed an improvement in verbal learning, and a significant number of AR subjects improved in general intelligence. Moreover, a higher than expected percentage of FE subjects, as well as AR subjects who later converted to psychosis, showed a deterioration in working memory and processing speed. These inconsistent trajectories suggest that some domains may improve with stabilization in the early stages of psychosis, whereas others may decline with progression of the illness, indicating possible targets for cognitive remediation strategies and candidate vulnerability markers for future psychosis.

Symptomatology and neuropsychological functioning in cannabis using subjects at ultra-high risk for developing psychosis and healthy controls

OBJECTIVE

The relationship between cannabis use and psychosis has been studied intensively. Few data, however, are available on the relationship between cannabis use, ultra-high risk for developing psychosis and neurocognition. The aim of the present cross-sectional study was therefore to investigate the relationship between cannabis use, ultra-high-risk (UHR) symptoms and cognitive functioning in UHR patients and healthy controls.

METHODS

A total of 63 ultra-high-risk patients (34 cannabis users) and 58 control subjects (28 cannabis users) were assessed with clinical measures and a neuropsychological test battery. Patients were eligible for the study if they were between the ages of 12 and 35 years and if they fell into one or more of the following inclusion groups: familial risk and reduced functioning, attenuated psychotic symptoms, brief limited intermittent psychotic symptoms and basic symptoms. Control subjects were eligible for the study if they were between the ages 12 and 35, had no present or past psychiatric illness, no family history of psychiatric illness, no drug use in the non-cannabis-using group, and use of at least four joints per week in the cannabis-using control group.

RESULTS

In the UHR and the control group, cannabis users experienced more basic symptoms and UHR symptoms than the non-cannabis users. Moreover, cannabis users in the control group performed at the level of the UHR subjects on a test of verbal memory and verbal fluency. Frequency of cannabis use correlated with severity of several UHR symptoms.

CONCLUSIONS

Cannabis-using UHR patients have more basic symptoms than non-using patients. In addition, healthy cannabis users have more subclinical UHR and basic symptoms and more neuropsychological dysfunctions than non-cannabis users. More frequent cannabis use was related to increased severity of certain UHR symptoms.

Neurobiological markers of illness onset in psychosis and schizophrenia: The search for a moving target

In this review, we describe neuropsychological and brain imaging findings in the early stages of psychosis and schizophrenia. We focus on recent clinical high-risk studies and consider whether the evidence supports these as 'endophenotypes' of a vulnerability to the illness or as 'biomarkers' of illness onset and transition. The findings suggest that there are a number of processes at psychosis onset that may represent biomarkers of incipient illness. These neurobiological indices particularly implicate the integrity of frontal and temporal cortices, which may or may not be related to the genetics of psychosis (i.e. potential 'endophenotypes'). However, these brain regions are dynamically changing during normal maturation, meaning that any putative neurobiological markers identified at the earliest stages of illness may be relatively unstable.We suggest that, while such measures maybe readily identified as potential neurobiological markers of established illness, they are inconsistent at (or around) the time of illness onset when assessed cross-sectionally. Instead,identification of more valid risk markers may require longitudinal assessment to ascertain normal or abnormal trajectories of neurodevelopment. Accordingly, we assert that the current conceptualisations of potential biomarkers and/or 'endophenotypes' for schizophrenia may need to be reconsidered in the context of normal and abnormal brain maturational processes at the time of onset of psychotic disorders.

Efficacy of using cognitive status in predicting psychosis: a 7-year follow-up

BACKGROUND

Despite extensive early detection research in schizophrenic psychoses, methods for identifying at-risk individuals and predicting their transition to psychosis are still unreliable. Moreover, there are sparse data on long-term prediction. We therefore investigated long-term psychosis transition in individuals with an At Risk Mental State (ARMS) and examined the relative efficacy of clinical and neuropsychological status in optimizing the prediction of transition.

METHODS

Sixty-four individuals with ARMS for psychosis were identified from all referrals to our early detection clinic between March 1, 2000 and February 29, 2004. Fifty-three (83%) were followed up for up to 7 (mean 5.4) years.

RESULTS

Twenty-one of the 53 staying in follow-up developed psychosis, corresponding to a transition rate of .34 (Kaplan-Meier estimates). Median time to transition was 10 months (range <1-55). Six of all transitions (29%) occurred only after 12 months from referral. Best transition predictors within this population were selected attenuated psychotic symptoms (suspiciousness), negative symptoms (anhedonia/asociality), and cognitive deficits (reduced speed of information processing). With these predictors in an integrated model for predicting transition to psychosis, the overall predictive accuracy was 80.9% with a sensitivity of 83.3% and a specificity of 79.3%.

CONCLUSIONS

Follow-up of ARMS subjects should exceed the usual 12 months. Prediction of transitions could be improved by a stronger weighting of certain early symptoms and by introducing neurocognitive tests into a stepwise risk assessment. Confirmatory research will hopefully further improve risk algorithm, including psychopathology and neuropsychological performance, for clinical application in early detection clinics.

Exploring predictors of outcome in the psychosis prodrome: implications for early identification and intervention

Functional disability is a key component of many psychiatric illnesses, particularly schizophrenia. Impairments in social and role functioning are linked to cognitive deficits, a core feature of psychosis. Retrospective analyses demonstrate that substantial functional decline precedes the onset of psychosis. Recent investigations reveal that individuals at clinical-high-risk (CHR) for psychosis show impairments in social relationships, work/school functioning and daily living skills. CHR youth also demonstrate a pattern of impairment across a range of cognitive domains, including social cognition, which is qualitatively similar to that of individuals with schizophrenia. While many studies have sought to elucidate predictors of clinical deterioration, specifically the development of schizophrenia, in such CHR samples, few have investigated factors relevant to psychosocial outcome. This review integrates recent findings regarding cognitive and social-cognitive predictors of outcome in CHR individuals, and proposes potential directions for future research that will contribute to targeted interventions and improved outcome for at-risk youth.

Use of neuroanatomical pattern classification to identify subjects in at-risk mental states of psychosis and predict disease transition

CONTEXT

Identification of individuals at high risk of developing psychosis has relied on prodromal symptomatology. Recently, machine learning algorithms have been successfully used for magnetic resonance imaging-based diagnostic classification of neuropsychiatric patient populations.

OBJECTIVE

To determine whether multivariate neuroanatomical pattern classification facilitates identification of individuals in different at-risk mental states (ARMS) of psychosis and enables the prediction of disease transition at the individual level.

DESIGN

Multivariate neuroanatomical pattern classification was performed on the structural magnetic resonance imaging data of individuals in early or late ARMS vs healthy controls (HCs). The predictive power of the method was then evaluated by categorizing the baseline imaging data of individuals with transition to psychosis vs those without transition vs HCs after 4 years of clinical follow-up. Classification generalizability was estimated by cross-validation and by categorizing an independent cohort of 45 new HCs.

SETTING

Departments of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.

PARTICIPANTS

The first classification analysis included 20 early and 25 late at-risk individuals and 25 matched HCs. The second analysis consisted of 15 individuals with transition, 18 without transition, and 17 matched HCs.

MAIN OUTCOME MEASURES

Specificity, sensitivity, and accuracy of classification.

RESULTS

The 3-group, cross-validated classification accuracies of the first analysis were 86% (HCs vs the rest), 91% (early at-risk individuals vs the rest), and 86% (late at-risk individuals vs the rest). The accuracies in the second analysis were 90% (HCs vs the rest), 88% (individuals with transition vs the rest), and 86% (individuals without transition vs the rest). Independent HCs were correctly classified in 96% (first analysis) and 93% (second analysis) of cases.

CONCLUSIONS

Different ARMSs and their clinical outcomes may be reliably identified on an individual basis by assessing patterns of whole-brain neuroanatomical abnormalities. These patterns may serve as valuable biomarkers for the clinician to guide early detection in the prodromal phase of psychosis.

Intervention to improve level of overall functioning and mental condition of adolescents at high risk of developing first-episode psychosis in Finland

AIM

Being at high risk of developing psychosis has been suggested to be a result of a combination of acute life stressors and trait-like vulnerability to psychosis. Reducing levels of stress could support overall functioning and mental condition in those at risk.

METHODS

The Jorvi Early Psychosis Recognition and Intervention (JERI) project at Helsinki University Central Hospital, Jorvi Hospital, Finland, is an early intervention team for adolescents at risk of developing first-episode psychosis. The project is based on the idea of multiprofessional, community, home, family and network-oriented, stress-reducing, overall functioning-supporting, low-threshold care. The JERI team meets multiprofessionally with adolescents in their natural surroundings, for example, at school or at home, together with their parents, network and community co-worker, who has originally contacted the JERI team because of unclear mental health problems. Subjects were assessed with the PROD-prodromal screen to identify those at risk of developing first-episode psychosis.

RESULTS

Statistically significant difference between baseline and follow-up measures was found in at risk subjects (n = 28) in scales of overall functioning (P = 0.000), depression (P = 0.001), anxiety (P = 0.001), quality of life (QOL) and pre-psychotic symptoms.

CONCLUSIONS

JERI-type intervention may improve level of overall functioning and support mental condition in adolescents at risk of developing first-episode psychosis, even though further study with larger numbers of subjects, with a control group and with a longer follow-up time, is needed.

Intervention in the at-risk state to prevent transition to psychosis

PURPOSE OF REVIEW

The number of intervention studies aiming to prevent psychosis is still small. Follow-up data of the first studies were published during the last year and neuroprotection has become an important issue.

RECENT FINDINGS

Initially superior effects of pharmacological or cognitive intervention reported by the first studies in the field became less clear about 3 years after cessation of intervention; however, a common problem of these first trials is a small sample size resulting in a lack of sufficient statistical power. The first studies of interventions thought to act as primarily neuroprotective yielded promising findings; however, further studies are needed to evaluate the preventive as well as the neuroprotective efficacy of these approaches.

SUMMARY

Besides methodologically sound studies, improved enrichment strategies are required as well as risk-adapted intervention strategies, guided by evidence-based clinical staging algorithms. Furthermore, the current concept of psychosis prevention, requiring an intervention to show long-lasting effects even after cessation, needs reconsideration. Approaches as used for relapse prevention in psychosis or for chronic at-risk states in internal medicine may help to maintain the initial superior prophylactic effects.

Neural correlates of executive function and working memory in the 'at-risk mental state'

BACKGROUND

People with prodromal symptoms have a very high risk of developing psychosis.

AIMS

To use functional magnetic resonance imaging to examine the neurocognitive basis of this vulnerability.

METHOD

Cross-sectional comparison of regional activation in individuals with an'at-risk mental state' (at-risk group: n=17), patients with first-episode schizophreniform psychosis (psychosis group: n=10) and healthy volunteers (controls: n=15) during an overt verbal fluency task and an N-back working memory task.

RESULTS

A similar pattern of between-group differences in activation was evident across both tasks. Activation in the at-risk group was intermediate relative to that in controls and the psychosis group in the inferior frontal and anterior cingulate cortex during the verbal fluency task and in the inferior frontal, dorsolateral prefrontal and parietal cortex during the N-back task.

CONCLUSIONS

The at-risk mental state is associated with abnormalities of regional brain function that are qualitatively similar to, but less severe than, those in patients who have recently presented with psychosis.

An integrated psychobiological predictive model of emergent psychopathology among young relatives at risk for schizophrenia

OBJECTIVE

Studies of young relatives at elevated risk for schizophrenia have pointed to the importance of a variety of neurobiological, cognitive, and clinical risk factors for the disorder; yet few have employed integrated models to estimate the joint contribution of these factors to heightened schizophrenic risk. We tested the predictive power of an integrated psychobiological model of schizophrenia risk to subsequent psychopathology development among young relatives at risk for the disorder.

METHODS

Young first (n=66) and second (n=20) degree relatives of schizophrenia probands were followed for an average of 3 (SD=1.13) years to examine their trajectories toward psychopathology development. Neurobiologic, cognitive, and clinical measures were employed in an integrated structural equation model to estimate their contribution to the prospective emergence of psychopathology.

RESULTS

Results indicated that neurobiological, neurocognitive, and psychosis proneness factors at baseline were all uniquely predictive of subsequent psychopathology development, and that an integrated model of psychopathology development that took into account these factors provided an excellent fit to the observed data. Subsequent classification analyses of model accuracy using likelihood ratios adjusting for the base-rate of psychopathology development in this sample revealed that individuals identified by this model had a 71% chance of developing psychopathology in the future.

CONCLUSIONS

An integrated model of biobehavioral risk factors may provide a powerful method for predicting psychopathology and schizophrenia risk in at-risk samples. If validated, this model may be useful for early detection and intervention programs. Future research will need to focus particularly on predicting schizophrenia development and refining models to further enhance sensitivity.

The concept of psychosis: historical and phenomenological aspects

The historical development of the concept of psychosis and its increasing differentiation from the neuroses up to the modern classification systems, Diagnostic and Statistical Manual of Mental Disorders and International Statistical Classification of Diseases, is initially presented. In portraying this development, the struggle surrounding the clinical relevance of concepts on the one hand and their reliability and validity on the other are reflected. Thus far, diagnostic reliability has primarily been improved by focusing on externally observable symptoms in connection with expression and behavior. The identification of disease-specific symptoms, however, is principally achieved through the differential description of subjective experience. How this experience is to be explored and assessed remains for the most part unclear. With reference to its founder Karl Jaspers, the phenomenological method is presented as the decisive instrument for the assessment of experience. It is shown that a return to the legacy of phenomenology and a reformulation of the long-standing question concerning the specific symptoms of the schizophrenic psychosis are currently in progress. The revival of historical knowledge and a focus on direct clinical phenomena continue to provide inspiration for further advancement in modern psychiatry.

Kraepelin and psychotic prodromal conditions

When Emil Kraepelin combined the formerly distinct entities of dementia paranoides, catatonia and hebephrenia to form the concept of 'dementia praecox' in 1896, he was well aware that this new disease entity--first coined 'schizophrenia' by Eugen Bleuler in 1908--does not generally only start off with the first psychotic manifestation. Even in his original observations, the characteristic psychotic phenomena developed via transition sequences from rather uncharacteristic prodromal disturbances. Meanwhile an initial prodromal condition was shown for about 75% of first-episode psychosis patients, lasting 5 years on average, possessing pathological significance and leading to psychosocial disruptions. Whereas most symptoms of the initial prodromal condition appear to be rather unspecific and hard to distinguish from other psychiatric conditions especially depressive ones, some syndromes seem to enable an early detection and thus an indicated prevention. These are constituted by attenuated and/or transient psychotic symptoms on the one hand and certain cognitive-perceptive basic symptoms on the other. Whereas the former are thought to delineate an advanced prodromal state, the latter can occur early in course and even at the beginning of the transition sequence to first-rank symptoms. This review will outline the current state of the art of a phase specific early detection and intervention based on these syndromes.

Reduced subjective quality of life in persons at risk for psychosis

OBJECTIVE

Subjective quality of life (sQoL) and potentially contributing factors were investigated in individuals putatively in an early (EIPS) or late initial prodromal state (LIPS) and healthy controls (HC).

METHOD

Participants comprised 58 EIPS individuals, 157 LIPS individuals and 87 HC individuals. sQoL was assessed together with locus of control (LoC), coping, demography and psychopathology.

RESULTS

Putatively prodromal groups exhibited markedly lower sQoL than HC (all domains P < 0.00001). EIPS and LIPS individuals did not differ significantly. Depression was the most consistent explaining variable of sQoL in EIPS and LIPS individuals. In EIPS individuals, LoC emerged as an additional predictor.

CONCLUSION

Individuals at risk for psychosis experienced a marked impairment of sQoL across all domains. This was evident even in the early state, showed no significant further deterioration during the late state and was predominantly explained by non-specific symptoms.

Neurocognition and conversion to psychosis in adolescents at high-risk

This study examined neurocognitive predictors of conversion to Axis I psychosis among adolescents at high-risk for psychosis (AHRP). There were no significant differences in neurocognitive performance between adolescents at high-risk for psychosis who converted (AHRP+) and adolescents at high-risk for psychosis who did not convert (AHRP-). Within-sex comparisons revealed a relation between risk status and performance among females, with AHRP+ performing below AHRP-, but this effect did not hold for males. Between-sex comparisons revealed AHRP- males performed worse than AHRP- females on several measures. Across groups, males performed better than their female counterparts on select measures. Results are discussed in terms of implications for use of neurocognitive profiles as bio-risk markers of psychosis, while considering sex differences.