Trajectories of symptom severity and functioning over a three-year period in a psychosis high-risk sample: A secondary analysis of the Neurapro trial

Jessica A Hartmann; Stefanie J Schmidt; Patrick D McGorry; Maximus Berger; Gregor E Berger; Eric Y H Chen; Lieuwe de Haan; Ian B Hickie; Suzie Lavoie; Connie Markulev; Nilufar Mossaheb; Dorien H Nieman; Merete Nordentoft; Andrea Polari; Anita Riecher-Rössler; Miriam R Schäfer; Monika Schlögelhofer; Stefan Smesny; Andrew Thompson; Swapna K Verma; Hok Pan Yuen; Alison R Yung; G Paul Amminger; Barnaby Nelson

doi:10.1016/j.brat.2019.103527

Trajectories of symptom severity and functioning over a three-year period in a psychosis high-risk sample: A secondary analysis of the Neurapro trial

Behav Res Ther. 2020 Jan:124:103527. doi: 10.1016/j.brat.2019.103527. Epub 2019 Nov 21.

Authors

Jessica A Hartmann¹, Stefanie J Schmidt², Patrick D McGorry³, Maximus Berger³, Gregor E Berger⁴, Eric Y H Chen⁵, Lieuwe de Haan⁶, Ian B Hickie⁷, Suzie Lavoie³, Connie Markulev³, Nilufar Mossaheb⁸, Dorien H Nieman⁶, Merete Nordentoft⁹, Andrea Polari³, Anita Riecher-Rössler¹⁰, Miriam R Schäfer³, Monika Schlögelhofer¹¹, Stefan Smesny¹², Andrew Thompson¹³, Swapna K Verma¹⁴, Hok Pan Yuen³, Alison R Yung³, G Paul Amminger³, Barnaby Nelson³

Affiliations

¹ Orygen, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia. Electronic address: Jessica.hartmann@orygen.org.au.
² Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland.
³ Orygen, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
⁴ Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital, University of Zurich, CH-8032, Zurich, Switzerland.
⁵ Department of Psychiatry, University of Hong Kong, Hong Kong, China.
⁶ Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands.
⁷ Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
⁸ Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria.
⁹ CORE-Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
¹⁰ University of Basel, Basel, Switzerland.
¹¹ Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria.
¹² Department of Psychiatry, Jena University Hospital, Jena, Germany.
¹³ Orygen, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Warwick Medical School, University of Warwick, Coventry, UK.
¹⁴ Institute of Mental Health, Singapore.

PMID: 31790853
DOI: 10.1016/j.brat.2019.103527

Abstract

The Ultra-High Risk (UHR) for psychosis group is known to be heterogeneous with diverse outcomes. This study aimed to: 1. Identify subclasses of UHR individuals based on trajectories of symptomatic and functional change over time, 2. Identify predictors of these trajectories. A sample of 304 UHR individuals participating in the Neurapro trial were followed over an average of 40 months. All participants received cognitive-behavioural case management (CBCM). Symptomatic and functional profiles were investigated using latent class growth analysis. Multinomial regression was employed to investigate predictors of classes. Identified trajectories showed mostly parallel slopes (i.e. improving symptoms/functioning over time), which were primarily distinct regarding the severity of symptomatology/level of functioning at baseline (i.e. the intercept). Higher symptomatic/lower functioning classes were predicted by higher substance use, older age, female gender, and lower cognitive functioning. No divergent trajectories were identified as all classes improved over time. This may reflect effective treatment through CBCM, natural illness course, or effective engagement with mental health services. Nonetheless, classes highest in symptoms/lowest in functioning still showed considerable impairment during follow-up, highlighting the need for targeted intervention in these subgroups. The study emphasizes the need for more clinical attention directed towards UHR patients being female or using substances.

Keywords: Latent class growth analysis; Longitudinal; Psychosis; Symptom trajectories; Ultra-high risk.

MeSH terms

Adolescent
Adult
Disease Progression
Female
Humans
Male
Psychiatric Status Rating Scales
Psychotic Disorders / diagnosis
Psychotic Disorders / psychology*
Severity of Illness Index
Young Adult