CORRELATES, TRANSITION RATE AND FUNCTIONAL OUTCOME OF CHILDREN AND ADOLESCENTS WITH ATTENUATED PSYCHOTIC SYMPTOMS: FINDINGS FROM A LONGITUDINAL STUDY

Background: In children and adolescents research on the high risk state and attenuated psychotic symptoms is still in its infancy and the clinical validity of at risk criteria appears understudied. Furthermore, only few studies have evaluated the psychopathological and neuropsychological characteristics and long-term outcomes of adolescents with attenuated psychotic symptoms (APS). Thus, in this longitudinal cohort study, we aimed to: (1) characterize the clinical profile of APS adolescents, adolescents suffering from early onset psychosis (EOP) and adolescents with psychiatric disorders other than APS and EOP (non-APS), (2) to calculate the cumulative transition rate to psychosis at follow-ups and investigate predictors of conversion to psychosis and 3) to study the effect of potential clinical prognostic factors in influencing functional outcome (socio-occupational functioning) at follow-up in APS adolescents. Methods: Help-seeking adolescents consecutively admitted to Child and Adolescent Neuropsychiatric units were recruited. The Comprehensive Assessment of At-Risk Mental State (CAARMS) was used in order to evaluate the presence of attenuated or full-blown psychotic symptoms. The final sample consisted of 31 EOP, 110 APS and 102 non-APS adolescents patients. At baseline patients underwent an extensive clinical and, in a subset, also neuropsychological assessment using standardized semi-structured interviews and instruments. All APS patients were followed up for a median period of 33 months and baseline measures were repeated (every 12 months). Transition to psychosis was defined according to the CAARMS criteria, while the level of functioning through the Social and Occupational Functioning Assessment Scale. Results: At baseline poor socio-occupational functioning, especially social functioning, as well as clinical severity as assessed by clinicians were significantly associated with APS status. APS adolescents reported a higher level of suicidality compared to non-APS. The APS group displayed a higher number of comorbid disorders compared to the EOP and non-APS and was not related to a single diagnosis or group of diagnoses, but to a wide range of disorders. The cumulative proportion of psychosis transition in the APS group was 13%, 17%, 24.2% and 26.8% at 1,2,3 and 4-years follow-ups, respectively. Baseline lower global and social functioning, higher clinical severity, negative symptoms, lower Total IQ and Processing Speed Index were associated with transitioning to psychosis at follow-ups. At follow-ups, APS adolescents, also the ones that did not developed psychosis, continued to display a significant impairment in socio-occupational functioning that persisted over time. Besides conversion status, a higher SOFAS and better social functioning and total IQ at baseline and not having a baseline diagnosis of anxiety disorders significantly predicted socio-occupational functioning at follow-up. Conclusions: Our findings support the validity and clinical relevance of the identification of APS in children and adolescents. Indeed, in our sample APS adolescents suffer from a variety of comorbidities and non-psychotic symptoms, present higher suicidality and are markedly impaired compared to non-psychotic adolescent not fulfilling APS criteria. Moreover, they show a cumulative transition risk to psychosis of 26.8% at 4 years that, although being lower than that found in adult samples, is still comparable to that of other conditions in preventive medicine. Besides the risk of transitioning, at follow-ups APS adolescents overall continued to display a significant impairment in socio-occupational functioning that persisted over time. Our data further show that APS adolescents are truly in need of care and treatment that should not only be focused on potential transition to psychosis, but also as on global and especially social functioning as well as current mental state and problems.