DISORGANIZED THINKING AND EMOTIONAL POVERTY ARE PRIMARY CLINICAL PREDICTORS OF FUNCTIONING IN PSYCHOSES. REANALYSIS OF THE TURKU EARLY PSYCHOSIS STUDY DATA

Abstract

Background: The functional outcomes of patients with a psychotic disorder have been associated with several overlapping clinical, neuropsychological and developmental factors. Aim: In a prospective study, we aimed to predict functional outcomes in patients with first-episode psychosis or clinically high risk for psychosis by sociodemographic, clinical, neuropsychological and premorbid factors and follow-up symptomatology. Methods: Altogether, 130 first-episode psychosis and 60 clinical high-risk patients were recruited, and their functioning was assessed at baseline and at 9- and 18-month follow-ups. The total follow-up functioning was predicted by baseline characteristics and factorized dimensions of baseline clinical symptoms, premorbid adjustment, childhood adversities, neuropsychological tests and follow-up symptoms. Results: Emotional Poverty and Disorganized Thinking, premorbid Sociability and Scholastic Performance, social support, baseline functioning, follow-up Depression/Anxiety and Psychoticism correlated significantly with follow-up functioning. In the regression model, follow-up functioning was significantly associated with Sociability and Scholastic Performance, Disorganized Thinking, work and marital status in the entire sample and in psychotic patients separately. In clinical high-risk patients, Emotional Poverty and follow-up depression/anxiety symptomatology were significantly associated with poor followup functioning. The effects of Sociability and School Performance on follow-up functioning were mediated via Emotional Poverty in both patient groups. Conclusion: In psychotic patients, poor premorbid adjustment, disorganized thinking, poor baseline work status and being single predicted poor follow-up functioning. The effect of premorbid adjustment on follow-up functioning was partly mediated via emotional poverty. In clinical high-risk patients, basic disturbances were affective disorders, and attenuated psychotic symptoms represented their severity.

Keywords

• functional outcome
• psychosis
• clinical high risk for psycosis
• premorbid psychosocial adjustment
• disorganized symptoms
• emotional poverty
• negative symptoms
• employment situation
• marital status