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Persistence or recurrence of non-psychotic comorbid mental disorders associated with 6-year poor functional outcomes in patients at ultra high risk for psychosis
Open accessAbstract
Background Patients at ultra-high risk for psychosis (UHR) are a highly heterogeneous group in terms of clinical and functional outcomes. Several non-psychotic mental disorders co-occur together with the UHR state. Little is known about the impact of non-psychotic comorbid mental disorders on clinical and functional outcomes of UHR patients.Methods The sample included 154 UHR help-seeking patients (identified with the CAARMS, comprehensive assessment of the at-risk mental state), evaluated at baseline on the Ham-D, Ham-A (Hamilton depression/anxiety rating scale), and PANSS (positive and negative syndrome scale). 74 patients completed the 6-year follow-up assessment (mean=6.19, SD=1.87). Comorbid disorders at follow-up were assessed with the SCID I and II. Global functioning was rated on the global assessment of functioning (GAF) scale.Results In the present sample, 6-year risk of psychosis transition was 28.4%. Among non-transitioned UHR patients, 28.3% reported attenuated psychotic symptoms (APS) and 45.3% remained functionally impaired at follow-up (GAF<60). 56.8% patients were affected by at least one comorbid disorder at follow-up. Among UHR patients who presented with some comorbid disorder at baseline, 61.5% had persistent or recurrent course. Incident comorbid disorders emerged in 45.4% of baseline UHR patients. The persistence or recurrence of non-psychotic comorbid mental disorders was associated with poorer global functional outcomes at follow-up.Limitations A substantial proportion of the initial sample was not available for follow-up interviews and some groups in the analyses had small sample size. Predictors of longitudinal outcomes were not explored.Conclusions Among UHR patients, persistence or recurrence of non-psychotic comorbid mental disorders, mostly affective disorders, is associated with 6-year poor functional outcomes.
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“The majority of CHR-P individuals have comorbid non-psychotic mental disorders (which do not increase the risk for psychosis but tend to persist over time 229 ), mostly common mental disorders: 41% depressive disorders and 15% anxiety disorders 72,230”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [229]
In the citing paper
“in addition to transition to psychosis, longer-term psychotic disorder, or persistent sub-threshold psychotic symptoms, progression to persistent mood, anxiety, personality and/or substance use disorders is also a very common outcome [25, 26]”
From Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care? (2020) · cites this paper as [26]
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“…in UHR samples are higher than prevalence rates of non-psychotic disorders in epidemiological studies of the general population (Charlson et al., 2013; Costello et al., 2003; Ferrari et al., 2013; Kessler et al., 2005a), suggesting a close concurrence of APS and comorbid disorders in UHR samples.”
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“Highly prevalent affective comorbid disorders are frequently observed in other mental disorders, and they occur in up to 50% of subjects with a psychiatric diagnosis (Demyttenaere et al., 2004; Kessler et al., 2005b).”
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Metadata
- Authors
- Rutigliano, G., Valmaggia, L., Landi, P., Frascarelli, M., Cappucciati, M., Sear, V., Rocchetti, M., De Micheli, A., Jones, C., Palombini, E., McGuire, P., & Fusar-Poli, P.
- Affiliations
- University of Pisa (IT)
- King's College London (GB)
- South London and Maudsley NHS Foundation Trust (GB)
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2016-10
- Volume
- 203
- Pages
- 101-110
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2417001166
- Cited by
- 138
- References
- 69
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 14 · 2023: 10 · 2022: 13 · 2021: 20 · 2020: 21 · 2019: 21 · 2018: 12 · 2017: 12 · 2016: 3
- FWCI
- 14.24
- Type
- journal article
- Language
- en
- Open access
- green
- kclpure.kcl.ac.uk
- Licence
- cc-by-nc-nd
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Keywords
- clinical high risk for psychosis, mood disorders, functional outcome, attenuated psychotic symptoms, global functioning, longitudinal follow-up
- MeSH terms
- Mental Disorders, Female, Humans, London, Male, Prognosis, Psychiatric Status Rating Scales, Psychotic Disorders, Recurrence, Risk Factors, Comorbidity, Young Adult, Prodromal Symptoms
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