10 Sep At-Risk Patients for Psychosis and Impaired Functional Outcomes
MedicalResearch.com Interview with:
Ricardo E. Carrión, PhD
Division of Psychiatry Research
The Zucker Hillside Hospital, North Shore–Long Island Jewish Health System, Glen Oaks, New YorkCenter for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, New York
MedicalResearch.com: What are the main findings of your study:
Answer: Reduced neurocognition, poor functioning, and other behavioral symptoms at baseline were associated with an increased risk of long-term social difficulties and school/work problems in adolescents and young adults at high clinical risk for psychosis.
MedicalResearch.com: Where any of the findings unexpected?
Answer: At the conclusion of our study, we found that a large portion of the CHR subjects in our sample had poor social and role functioning, regardless of the development of a full-blown psychosis. In fact, one third (32.6%) of the sample continued to have relationship and school/work difficulties. This is a quite high rate and represents a public health problem in its own right. These results emphasize the need for a flexible perspective on outcome in at-risk individuals. Functional disability is not solely dependent on the progression of full-blown psychosis, because many individuals who did not convert continued to present with poor functioning.
MedicalResearch.com: What should patients and clinicians take away from this report?
Answer: We now recognize that adolescents who display early warning signs of later psychiatric illness, especially psychosis, have a variety of functional disabilities that can profoundly influence educational attainment, work objectives, and social interactions, even if full psychosis doesn’t develop. Most intervention studies so far have focused on prevention of progression to psychosis. By identifying individuals vulnerable to later functional disability during adolescence, we expect to develop interventions before illness progression, at a time when treatment will be most effective. Our emphasis is to avoid medication when possible and focus on psychosocial treatments that we expect to be effective at young ages.
MedicalResearch.com: What recommendations do you have for future research as a result of your study?
Answer: In light of evidence that a large proportion of individuals at clinical high risk do not develop full-blown psychosis, finding markers that may identify patients at high risk for functional impairments may provide a pathway to prevent the disability associated with the illness. These teenagers and young adults are both at risk for psychosis and functional disability. Prevention is needed for emerging psychosis, as well as for helping these individuals cope with persistent relationship and occupational problems.
Also, from a clinical perspective, our emphasis is to development treatments recommended by our research findings. In the future, we will be stressing improving social skill development and work adaptation. At present, though, we are conducting a trial evaluating the effects of Omega 3 Fatty Acid or fish oil on symptoms and functional deficits. The fish oil trial is still open and accepting volunteers who meet our at-risk criteria.
Carrión RE, McLaughlin D, Goldberg TE, et al. Prediction of Functional Outcome in Individuals at Clinical High Risk for Psychosis. JAMA Psychiatry. 2013;():-. doi:10.1001/jamapsychiatry.2013.1909.