T117. Functional Trajectory in First-episode Psychosis Based on Premorbid Iq and Age of Onset
Year: 2019
Type: conference-abstract
Abstract: Early age of onset of psychotic symptoms has been associated with poor functional prognosis in individuals with a first episode of psychosis before the age of 18 (EOP) in comparison with adult onset of psychosis (i.e. after age of 18; AOP; Immonen et al., 2017). Premorbid intelligence quotient (pIQ), which has shown to play an important role over longitudinal functioning (Bombin et al., 2013), is one of the factors that has been associated with age of onset (AO) in schizophrenia (Khandaker et al., 2011). However, in FEP individuals the relationship between premorbid pIQ and AO and the effect of both factors over clinical and functional outcomes has not yet been clarified. To clarify this issue, the present study aims to characterize FEP individuals in subgroups based on the former variables: premorbid IQ and age-of-onset and to examine functional and clinical trajectories of participants at two years follow-up. A sample of N=374 individuals with a FEP and a wide range of AO (9–35 years of age) was included in the current study. A total of N=256 completed the correspondent 2-year follow-up assessments. The estimation of pIQ was conducted at baseline using the Spanish version of the vocabulary subtest of the WISC-IV (Wechsler, 1997) or WAIS-III (Wechsler, 2003). The AO of psychotic symptoms was evaluated retrospectively according to the reports from the patient and his/her family. At the baseline and at 2-year follow-up, the general functioning was assessed through the Global Assessment of Functioning Scale (GAF) or the Children Global Assessment of Functioning Scale respectively. Clinical assessment were conducted with the Positive and Negative Symptom Scale PANSS and we used Andreasen′ remission criteria (Andreasen et al., 2005) based on the PANSS scores to estimate the remission of symptoms in each patient. The whole sample was divided in four groups based on AO of positive symptoms (<18/ ≥18), and the presentation of pIQ below average or in the average (IQ<90 / IQ≥90). Demographic and clinical characteristics between groups of patients were compared with ANOVA and chi-square tests correspondingly. General functioning was analyzed through general lineal model for repeated measures. Remission of symptomatology was analyzed with pairwise comparison chi-square tests. Finally, a series of hierarchical regression models were used to examine the association of pIQ, AoO and premorbid adjustment. At baseline, both EOP subgroups (EOP<90 and EOP≥90 group) showed higher scores in total symptomatology on the PANSS (F=5.53 p<0.001) and lower functioning on the GAF scale (F=25.42, p<0.001) than the groups of AOP. Functional trajectory was significantly different between the EOP<90 group and the other of groups (EOP≥90 group, AOP<90, AOP≥90). No significant differences were found between trajectories of groups of AAO. The group of patients EOP<90 showed a higher rate of no-remission of symptomatology in comparison with the other groups X2 (5.81) p<.016. The multiple regression model significantly predicted functional GAF scores of F (3, 95) = 7.69, p< .001. This model explained a 7.6% of two years follow-up global functioning scores. All three variables added statistically significantly to the prediction, p<.001. The concurrence of early presentation of psychotic symptoms in patients with under-average premorbid IQ may be an indicator of worse functional and symptomatology outcomes 2-years after the illness onset. According with our results, age of onset and premorbid IQ at the moment at first episode of psychosis can be used as clinical reliable indicators of longitudinal functional prognosis.
Source: Schizophrenia Bulletin
Authors: María Dolores García, Marta Rapado-Castro, David Fraguas, Mara Parellada, Celso Arango, Josefina Castro-Fornieles, Manuel J Cuesta, Miquel Bernardo
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2939471387