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Factors Associated With Psychosocial Functioning and Outcome of Individuals With Recent-Onset Schizophrenia and at Ultra-High Risk for Psychosis

 Hyun Kyu Kim  ;  Hye Yoon Park  ;  Eunchong Seo  ;  Minji Bang  ;  Yun Young Song  ;  Su Young Lee  ;  Kyung Ran Kim  ;  Jin Young Park  ;  Jee In Kang  ;  Eun Lee  ;  Suk Kyoon An 
 FRONTIERS IN PSYCHIATRY, Vol.10 : 459, 2019 
Journal Title
Issue Date
conversion ; psychosocial function ; readmission ; schizophrenia ; ultra-high risk for psychosis
Background: Patients with schizophrenia have impairments in social functioning and are readmitted to healthcare institutions frequently. Individuals at ultra-high risk (UHR) for psychosis already present poor social functioning; among those individuals, the conversion rate from the putative prodromal phase to overt psychosis is 20%-30% within 1-2 years. Here, we analyzed the factor structure of self-related variables and neuro- and socio-cognitive function, and investigated whether these factors were associated with psychosocial function and prognostic outcome in individuals with recent-onset schizophrenia (ROSPR) or at UHR for psychosis. Methods: We evaluated 60 individuals at UHR for psychosis, 47 individuals with ROSPR, and 71 healthy controls using a comprehensive neurocognitive test battery and self-reported attribution scales, self-esteem, resilience, aberrant subjective experiences of schizotypy (physical anhedonia, social anhedonia, magical ideation, and perceptual aberration), and basic symptoms. We assessed psychosocial function with the Quality of Life Scale (QLS). Results: Factor analysis of all subjects revealed a four-factor structure comprising social-cognitive bias, reflective self, neurocognition, and pre-reflective self factors. Multiple regression analysis at baseline revealed that the factor structure predicted QLS. In the UHR group, social-cognitive bias, reflective self, neurocognition, and negative symptoms were significant determinants, explaining 38.0% of total QLS score variance. In the ROSPR group, reflective self and negative symptoms were significant determinants, explaining 54.4% of total QLS score variance. During follow-up, 13 individuals at UHR for psychosis developed psychosis (cumulative prevalence: 31.2% ± 7.6% at 6 years), with neurocognition score at baseline remaining a significant predictor of conversion [χ2(1) = 4.009, p = 0.045; hazard ratio 0.56, 95% confidence interval 0.31-0.99, p = 0.048]. Five patients with schizophrenia were (re)admitted during follow-up (cumulative prevalence: 16.1% ± 7.1% at 6 years); no factor was found to predict (re)admission. Conclusion: Factor analysis revealed an intrinsic four-factor structure of social-cognitive bias, reflective self, neurocognition, and pre-reflective self. The four factors were associated with social functioning at baseline and prodrome-to-psychosis conversion during follow-up, indicating the clinical significance of the four-factor structure. These findings provide a framework for understanding schizophrenia.
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1. College of Medicine (의과대학) > Dept. of Psychiatry (정신과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Jee In(강지인) ORCID logo https://orcid.org/0000-0002-2818-7183
Kim, Kyung Ran(김경란) ORCID logo https://orcid.org/0000-0001-8375-1851
Kim, Hyun Kyu(김현규) ORCID logo https://orcid.org/0000-0001-5862-9168
Park, Jin Young(박진영) ORCID logo https://orcid.org/0000-0002-5351-9549
Park, Hye Yoon(박혜윤) ORCID logo https://orcid.org/0000-0001-9579-8112
Seo, Eunchong(서은총) ORCID logo https://orcid.org/0000-0003-2644-266X
An, Suk Kyoon(안석균) ORCID logo https://orcid.org/0000-0003-4576-6184
Lee, Su Young(이수영)
Lee, Eun(이은) ORCID logo https://orcid.org/0000-0002-7462-0144
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