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Premorbid functional development and conversion to psychosis in clinical high-risk youths

Published online by Cambridge University Press:  08 November 2013

Sarah I. Tarbox ,
Jean Addington ,
Kristin S. Cadenhead ,
Tyrone D. Cannon ,
Barbara A. Cornblatt ,
Diana O. Perkins ,
Larry J. Seidman ,
Ming T. Tsuang ,
Elaine F. Walker  and
Robert Heinssen
...Show all authors
Sarah I. Tarbox*
Affiliation:
Yale University School of Medicine
Jean Addington
Affiliation:
University of Calgary
Kristin S. Cadenhead
Affiliation:
University of California, San Diego
Tyrone D. Cannon
Affiliation:
University of California, Los Angeles
Barbara A. Cornblatt
Affiliation:
Zucker Hillside Hospital Albert Einstein College of Medicine Feinstein Institute for Medical Research
Diana O. Perkins
Affiliation:
University of North Carolina at Chapel Hill
Larry J. Seidman
Affiliation:
Harvard Medical School
Ming T. Tsuang
Affiliation:
University of California, San Diego Harvard Institute of Psychiatric Epidemiology and Genetics
Elaine F. Walker
Affiliation:
Emory University
Robert Heinssen
Affiliation:
National Institute of Mental Health
Thomas H. McGlashan
Affiliation:
Yale University School of Medicine
Scott W. Woods
Affiliation:
Yale University School of Medicine
*
Address correspondence and reprint requests to: Sarah I. Tarbox, PRIME Research Clinic, Connecticut Mental Health Center, Yale University School of Medicine, 34 Park Street, B-38, New Haven, CT 06519; E-mail: [email protected].
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Abstract

Deterioration in premorbid functioning is a common feature of schizophrenia, but sensitivity to psychosis conversion among clinical high-risk samples has not been examined. This study evaluates premorbid functioning as a predictor of psychosis conversion among a clinical high-risk sample, controlling for effects of prior developmental periods. Participants were 270 clinical high-risk individuals in the North American Prodrome Longitudinal Study—I, 78 of whom converted to psychosis over the next 2.5 years. Social, academic, and total maladjustment in childhood, early adolescence, and late adolescence were rated using the Cannon–Spoor Premorbid Adjustment Scale. Early adolescent social dysfunction significantly predicted conversion to psychosis (hazard ratio = 1.30, p = .014), independently of childhood social maladjustment and independently of severity of most baseline positive and negative prodromal symptoms. Baseline prodromal symptoms of disorganized communication, social anhedonia, suspiciousness, and diminished ideational richness mediated this association. Early adolescent social maladjustment and baseline suspiciousness together demonstrated moderate positive predictive power (59%) and high specificity (92.1%) in predicting conversion. Deterioration of academic and total functioning, although observed, did not predict conversion to psychosis. Results indicate early adolescent social dysfunction to be an important early predictor of conversion. As such, it may be a good candidate for inclusion in prediction algorithms and could represent an advantageous target for early intervention.

Type
Regular Articles
Information
Development and Psychopathology , Volume 25 , Issue 4pt1 , November 2013 , pp. 1171 - 1186
Copyright
Copyright © Cambridge University Press 2013 

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