Predictors of functional outcome in individuals at high clinical risk for psychosis at six years follow-up

Background: The long-term functional status of subjects at ultra high risk for psychosis (HR) is relatively under investigated. This study explores baseline predictors of long-term functional outcome in HR subjects who did not convert to psychosis during a 6 years follow-up period. Methods: A total of 154 HR were followed up for an average of 6 years. The primary outcome variable was global assessment of functioning at the last follow-up visit as assessed with the Global Assessment of Functioning tool. A multinomial logistic regression was performed to identify potential predictors of functional outcome. Results: Baseline and follow-up data on functioning was available for 92 HR. Twenty-four (43%) individuals who did not convert to psychosis reported poor functioning at follow-up. Baseline scores in the GAF (Exp(b)=0.857; 95% CIs: 0.75/0.97), employment status (Exp(b)=0.029; 95% CIs: 0.00/0.268), and CAARMS total scores (Exp(b)=1.976; 95% CIs: 1.00/1.14) predicted functional outcome in HR subjects at 6 years. Conclusions: Despite the preventive treatments received, many individuals who did not convert to full-blown psychosis in the longer term do not functionally remit. These individuals are lower functioning, unemployed and have higher symptom loading at the time of their presentation to the prodromal clinic. Our study suggests the need for innovative treatments targeting long term functional status beyond the prevention of psychosis onset in the HR population. •Functional outcomes should become the mainstream target in HR.•Interventions focused on the prevention of social disability should be promoted.•Understanding of functional outcome contributes to neurodevelopmental hypothesis.