Persistence Or Recurrence Of Non-Psychotic Comorbid Mental Disorders Associated With 6-Year Poor Functional Outcomes In Patients At Ultra High Risk For Psychosis

Background:Patients at ultra-high risk for psychosis (UHR) are a highly heterogeneous group in terms of clinical and functional outcomes. Several non-psychotic mental disorders co-occur together with the UHR state. Little is known about the impact of non-psychotic comorbid mental disorders on clinical and functional outcomes of UHR patients.Methods:The sample included 154 UHR help-seeking patients (identified with the CAARMS, Comprehensive Assessment of the At-Risk Mental State), evaluated at baseline on the Ham-D, Ham-A (Hamilton Depression/Anxiety Rating Scale), and PANSS (Positive and Negative Syndrome Scale). 74 patients completed the 6-year follow-up assessment (mean=6.19, SD=1.87). Comorbid disorders at follow-up were assessed with the SCID I and II. Global functioning was rated on the Global Assessment of Functioning (GAF) scale.Results:In the present sample, 6-year risk of psychosis transition was 28.4%. Among non-transitioned UHR patients, 28.3% reported Attenuated Psychotic Symptoms (APS) and 45.3% remained functionally impaired at follow-up (Global Assessment of Functioning, GAF < 60). 56.8% patients were affected by at least one comorbid disorder at follow-up. Among UHR patients who presented with some comorbid disorder at baseline, 61.5% had persistent or recurrent course. Incident comorbid disorders emerged in 45.4% of baseline UHR patients. The persistence or recurrence of non-psychotic comorbid mental disorders was associated with poorer global functional outcomes at follow-up.Limitations:A substantial proportion of the initial sample was not available for follow-up interviews and some groups in the analyses had small sample size. Predictors of longitudinal outcomes were not explored.Conclusions:Among UHR patients, persistence or recurrence of non-psychotic comorbid mental disorders, mostly affective disorders, is associated with 6-year poor functional outcomes.