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Impact of Comorbid Affective Disorders on Longitudinal Clinical Outcomes in Individuals at Ultra-high Risk for Psychosis

Frederike Schirmbeck 1, 2 Nadine van der Burg 1, 3 Matthijs Blankers 1, 2, 4 Jentien Vermeulen 1 Philip Mcguire 5 Lucia Valmaggia 5 Matthew Kempton 5 Mark van der Gaag 6, 7 Anita Riecher-Rössler 8 Rodrigo Bressan 9 Neus Barrantes-Vidal 10, 11 Barnaby Nelson 12, 13 G Paul Amminger 12 Patrick Mcgorry 12, 13 Christos Pantelis 13, 14 Marie-Odile Krebs 15, 16 Stephan Ruhrmann 17 Gabriele Sachs 18 Bart Rutten 19 Jim van Os 5, 19, 20 Merete Nordentoft 21 Birte Glenthøj 21 Paolo Fusar-Poli 22, 23, 5 Lieuwe de Haan 1, 2
Abstract : Introduction: Diagnoses of anxiety and/or depression are common in subjects at Ultra-High Risk for Psychosis (UHR) and associated with extensive functional impairment. Less is known about the impact of affective comorbidities on the prospective course of attenuated psychotic symptoms (APS). Method: Latent class mixed modelling identified APS trajectories in 331 UHR subjects assessed at baseline, 6, 12, and 24 months follow-up. The prognostic value of past, baseline, and one-year DSM-IV depressive or anxiety disorders on trajectories was investigated using logistic regression, controlling for confounders. Cox proportional hazard analyses investigated associations with transition risk. Results: 46.8% of participants fulfilled the criteria for a past depressive disorder, 33.2% at baseline, and 15.1% at one-year follow-up. Any past, baseline, or one-year anxiety disorder was diagnosed in 42.9%, 37.2%, and 27.0%, respectively. Participants were classified into one of three latent APS trajectory groups: (1) persistently low, (2) increasing, and (3) decreasing. Past depression was associated with a higher risk of belonging to the increasing trajectory group, compared to the persistently low (OR = 3.149, [95%CI: 1.298-7.642]) or decreasing group (OR = 3.137, [1.165-8.450]). In contrast, past (OR = .443, [.179-1.094]) or current (OR = .414, [.156-1.094]) anxiety disorders showed a trend-level association with a lower risk of belonging to the increasing group compared to the persistently low group. Past depression was significantly associated with a higher risk of transitioning to psychosis (HR = 2.123, [1.178-3.828]). Conclusion: A past depressive episode might be a particularly relevant risk factor for an unfavorable course of APS in UHR individuals. Early affective disturbances may be used to advance detection, prognostic, and clinical strategies.
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Submitted on : Tuesday, August 24, 2021 - 9:42:39 AM
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Frederike Schirmbeck, Nadine van der Burg, Matthijs Blankers, Jentien Vermeulen, Philip Mcguire, et al.. Impact of Comorbid Affective Disorders on Longitudinal Clinical Outcomes in Individuals at Ultra-high Risk for Psychosis. Schizophrenia Bulletin, Oxford University Press (OUP), 2021, pp.sbab088. ⟨10.1093/schbul/sbab088⟩. ⟨inserm-03324843⟩

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