Negative psychotic symptoms and impaired role functioning predict transition outcomes in the at-risk mental state: a latent class cluster analysis study
Open accessAbstract
BACKGROUND: Many research groups have attempted to predict which individuals with an at-risk mental state (ARMS) for psychosis will later develop a psychotic disorder. However, it is difficult to predict the course and outcome based on individual symptoms scores. METHOD: Data from 318 ARMS individuals from two specialized services for ARMS subjects were analysed using latent class cluster analysis (LCCA). The score on the Comprehensive Assessment of At-Risk Mental States (CAARMS) was used to explore the number, size and symptom profiles of latent classes. RESULTS: LCCA produced four high-risk classes, censored after 2 years of follow-up: class 1 (mild) had the lowest transition risk (4.9%). Subjects in this group had the lowest scores on all the CAARMS items, they were younger, more likely to be students and had the highest Global Assessment of Functioning (GAF) score. Subjects in class 2 (moderate) had a transition risk of 10.9%, scored moderately on all CAARMS items and were more likely to be in employment. Those in class 3 (moderate-severe) had a transition risk of 11.4% and scored moderately severe on the CAARMS. Subjects in class 4 (severe) had the highest transition risk (41.2%), they scored highest on the CAARMS, had the lowest GAF score and were more likely to be unemployed. Overall, class 4 was best distinguished from the other classes on the alogia, avolition/apathy, anhedonia, social isolation and impaired role functioning. CONCLUSIONS: The different classes of symptoms were associated with significant differences in the risk of transition at 2 years of follow-up. Symptomatic clustering predicts prognosis better than individual symptoms.
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People without a need for care were differentiated from patients by an absence of paranoia, cognitive difficulties, and negative symptoms.
“People without a need for care were differentiated from patients by an absence of paranoia, cognitive difficulties, and negative symptoms, which is in line with evidence that these issues are more predictive of transition to psychosis and poor functional outcomes than perceptual disturbances in ultra-high-risk individuals.5, 6”
From Clinical relevance of appraisals of persistent psychotic experiences in people with and without a need for care: an experimental study (2017) · cites this paper as [5]
The Introduction (p. 2) says negative and cognitive symptoms may predict psychosis better than positive symptoms, and Differences between risk classes (p. 11) links negative symptoms to transition and poor long-term outcomes. The paper does not support the full comparison attributed to it: it does not identify paranoia as more predictive than perceptual disturbances, or establish that all three named issues outperform perceptual disturbances for poor functional outcomes. The opening comparison between people without a need for care and patients is the citing authors’ own finding, not a finding attributed to this source. (LLM, conf=0.85)
Experimental — accuracy not yet measuredRecent evidence shows that positive symptoms in individuals at ultra-high-risk for psychosis are weaker predictors of transition to psychosis and poor functional outcome than negative and disorganized symptoms.
“recent evidence that positive symptoms in individuals at ultra-high-risk for psychosis are weaker predictors of transition to psychosis and a poor functional outcome than negative and disorganized symptoms 72”
From Clinical, socio‐demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a “need for care” (2016) · cites this paper as [72]
The Introduction (p. 2) says positive symptoms alone are poor predictors of longitudinal outcomes, and Differences between risk classes (p. 11) links negative rather than positive symptoms to transition and long-term outcome. The paper does not establish the same comparative predictive claim for disorganized symptoms; its risk classes were best distinguished by negative symptoms, social isolation and impaired role functioning (p. 11). (LLM, conf=0.86)
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Fowler, D., Berry, C., Hodgekins, J., Banerjee, R., Barton, G., Byrne, R., Clarke, T., Fraser, R., Grant, K., Greenwood, K., et al. (2021) · Health Technology Assessment · doi:10.3310/hta25700 · Cited by 7 · see citing works
- Authors
- Valmaggia, L. R., Stahl, D., Yung, A. R., Nelson, B., Fusar-Poli, P., McGorry, P. D., & McGuire, P. K.
- Affiliations
- King's College London (GB)
- The University of Melbourne (AU)
- Corresponding author
- Valmaggia, L. R.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2013-02-27
- Volume
- 43
- Issue
- 11
- Pages
- 2311-2325
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2088412242
- Cited by
- 121
- References
- 79
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 5 · 2023: 5 · 2022: 6 · 2021: 6 · 2020: 17 · 2019: 7 · 2018: 12 · 2017: 15 · 2016: 10 · 2015: 13 · 2014: 10 · 2013: 2
- FWCI
- 8.27
- Type
- journal article
- Language
- en
- Open access
- green
- kclpure.kcl.ac.uk
- Licence
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- Figshare (submittedVersion, cc-by)
- Funders
- National Alliance for Research on Schizophrenia and Depression
- National Institute for Health and Care Research
- King's College London
- 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, negative psychotic symptoms, role functioning, symptom profiles, CAARMS, outcome prediction, alogia, avolition, anhedonia, social isolation, Global Assessment of Functioning, latent class clustering
- MeSH terms
- Adolescent, Adult, Age Factors, Aphasia, Employment, Female, Humans, Male, Psychotic Disorders, Risk Factors, Social Isolation, Unemployment, Cluster Analysis, Disease Progression, Risk Assessment, Early Diagnosis, Young Adult, Apathy, Anhedonia, Early Medical Intervention, Prodromal Symptoms
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