Short-term functional outcome and premorbid adjustment in clinical high-risk patients. Results of the EPOS project

2014 ◽  
Vol 29 (6) ◽  
pp. 371-380 ◽  
Author(s):  
R.K.R. Salokangas ◽  
M. Heinimaa ◽  
T. From ◽  
E. Löyttyniemi ◽  
T. Ilonen ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Psychosocial Adjustment ◽  
Help Seeking ◽  
Work Status ◽  
Clinical High Risk ◽  
Short Term ◽  
Basic Symptoms ◽  
Premorbid Adjustment ◽  
Gaf Scores

AbstractPurposeIn patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their childhood to adolescence premorbid adjustment.MethodsIn all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganised, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9-month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analysed.ResultsDuring the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 74% to 37%. Poor premorbid adjustment, single marital status, poor work status, and symptoms were associated with low baseline GAF scores. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model.ConclusionA great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are carried out.

scholarly journals S64. COGNITIVE IMPAIRMENTS AND PREDICTION OF FUNCTIONAL OUTCOME IN INDIVIDUALS AT CLINICAL HIGH-RISK FOR PSYCHOSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S57-S58
Author(s):  
Kate Haining ◽  
Gina Brunner ◽  
Ruchika Gajwani ◽  
Joachim Gross ◽  
Andrew Gumley ◽  
...  
Keyword(s):  
Machine Learning ◽  
High Risk ◽  
Functional Outcome ◽  
Processing Speed ◽  
Cross Validation ◽  
Clinical High Risk ◽  
Role Functioning ◽  
Gaf Scores ◽  
Fold Cross Validation

Abstract Background Research in individuals at clinical-high risk for psychosis (CHR-P) has focused on developing algorithms to predict transition to psychosis. However, it is becoming increasingly important to address other outcomes, such as the level of functioning of CHR-P participants. To address this important question, this study investigated the relationship between baseline cognitive performance and functional outcome between 6–12 months in a sample of CHR-P individuals using a machine-learning approach to identify features that are predictive of long-term functional impairments. Methods Data was available for 111 CHR-P individuals at 6–12 months follow-up. In addition, 47 CHR-negative (CHR-N) participants who did not meet CHR criteria and 55 healthy controls (HCs) were recruited. CHR-P status was assessed using the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Schizophrenia Proneness Instrument, Adult version (SPI-A). Cognitive assessments included the Brief Assessment of Cognition in Schizophrenia (BACS) and the Penn Computerized Neurocognitive Battery (CNB). Global, social and role functioning scales were used to measure functional status. CHR-P individuals were divided into good functional outcome (GFO, GAF ≥ 65) and poor functional outcome groups (PFO, GAF < 65). Feature selection was performed using LASSO regression with the LARS algorithm and 10-fold cross validation with GAF scores at baseline as the outcome variable. The following features were identified as predictors of GAF scores at baseline: verbal memory, verbal fluency, attention, emotion recognition, social and role functioning and SPI-A distress. This model explained 47% of the variance in baseline GAF scores. In the next step, Support Vector Machines (SVM), Linear Discriminant Analysis (LDA), Logistic Regression (LR), Gaussian Naïve Bayes (GNB), and Random Forest (RF) classifiers with 10-fold cross validation were then trained on those features with GAF category at follow-up used as the binary label column. Models were compared using a calculated score incorporating area under the curve (AUC), accuracy, and AUC consistency across runs, whereby AUC was given a higher weighting than accuracy due to class imbalance. Results CHR-P individuals had slower motor speed, reduced attention and processing speed and increased emotion recognition reaction times (RTs) compared to HCs and reduced attention and processing speed compared to CHR-Ns. At follow-up, 66% of CHR-P individuals had PFO. LDA emerged as the strongest classifier, showing a mean AUC of 0.75 (SD = 0.15), indicating acceptable classification performance for GAF category at follow-up. PFO was detected with a sensitivity of 75% and specificity of 58%, with a total mean weighted accuracy of 68%. Discussion The CHR-P state was associated with significant impairments in cognition, highlighting the importance of interventions such as cognitive remediation in this population. Our data suggest that the development of features using machine learning approaches is effective in predicting functional outcomes in CHR-P individuals. Greater levels of accuracy, sensitivity and specificity might be achieved by increasing training sets and validating the classifier with external data sets. Indeed, machine learning methods have potential given that trained classifiers can easily be shared online, thus enabling clinical professionals to make individualised predictions.

scholarly journals S69. CLINICAL HIGH RISK STATE: STRATIFICATION BASED ON CLINICAL PROFILE AND REDOX STATUS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S60-S60
Author(s):  
Martine Cleusix ◽  
Ines Khadimallah ◽  
Elodie Toffel ◽  
Paul Klauser ◽  
Kim Q Do ◽  
...  
Keyword(s):  
High Risk ◽  
Psychosocial Functioning ◽  
Help Seeking ◽  
Verbal Learning ◽  
Self Esteem ◽  
Cognitive Outcomes ◽  
Clinical Profile ◽  
Clinical High Risk ◽  
Basic Symptoms ◽  
The Impact

Abstract Background The Clinical High Risk state (CHR) concept was implemented to promote the early detection of young help-seeking patients with higher risk of psychotic transition. This category is based on specific clinical criteria (EPA, 2015) and require narrow frequency/duration ratings of subclinical positive psychotic symptoms to allow its definition. Prevalence of CHR “category” appears nevertheless rare in help-seeking young people and the rate of psychotic transition of CHR state is lower than predicted by early studies. Therefore, the binary outcome of transition to psychosis proposed by the “CHR model” actually fails to be an efficient marker to stratify, in neurobiological studies, people with different psychopathological trajectories, notably those who develop psychosis from those who do not. In order to rely on a vulnerability model for schizophrenic psychosis more sensitive to psychosocial functioning and negative dimension, we study prospectively with three years of follow-up a population of help-seekers addressed for clinical suspicion of prodromal state of psychosis. We aimed here to identify subgroups of patients in a sample of subclinical psychotic states using psychological and cognitive outcomes as profiling criteria, focusing not only on transition but also on psychosocial functioning as main outcome. Methods A total of 32 help-seeking adolescents and young adults aged 14 to 35 were referred by health care providers for a specialized evaluation in case of suspicion of a prodromal psychotic state and/or detected by the French version of the Prodromal Questionnaire (PQ-16; cut-off 6/16). Their CHR status was assessed by the Structured Interview for Psychosis-Risk Syndromes (SIPS) and the Schizophrenia Proneness Instrument, Adult (SPI-A). Individuals included in the study presented either a CHR status, a subclinical CHR status or negative symptomatology. All subjects performed an additional neuropsychological battery and blood test for redox markers (Glutathione Peroxidase (GPx) and Glutathione Reductase (GR) activities) (Xin et al, 2016). Based on their clinical profile, we made a stratification of the patients using a Principal Component Analysis. Results Cognitive and psychological outcome stratification of all help-seekers revealed two subgroups (called group1 and group2) of patients with distinct profiles. Individuals in group1 (n=18) had greater levels of basic symptoms and general symptomatology. On the other hand, in group2 (n=14), individuals showed a weaker self-esteem and a lower rate of “living independently”. Cognitive scores for speed processing, attention, verbal learning and social cognition were significantly lower in group2 compared to group1. In addition, these cognitive outcomes were negatively correlated with negative symptoms only in group2. Analysis of redox markers revealed a positive correlation between GPx and GR activities in group1, a correlation disrupted in group2. Discussion Stratification of a cohort of young help-seekers with suspicion of prodromal psychosis, regardless of their CHR status, allowed us to distinguish two subgroups with different clinical profiles: group1 with higher levels of basic symptoms and general symptomatology, and group2 with weaker self-esteem, less autonomy and poorer neurocognition. In addition, analysis of redox markers revealed a redox dysregulation in patients with poorer cognitive profile. Considering the impact of neurocognitive impairment on functioning, special focus to patients of group2 is needed, mostly in clinical practice. Moreover, they might benefit of supplementation with antioxidant compounds such as NAC, which may improve cognitive deficits (Conus et al, 2018).

scholarly journals Two-year follow-up of a Chinese sample at clinical high risk for psychosis: timeline of symptoms, help-seeking and conversion

2016 ◽  
Vol 26 (3) ◽  
pp. 287-298 ◽  
Author(s):  
T. H. Zhang ◽  
H. J. Li ◽  
K. A. Woodberry ◽  
L. H. Xu ◽  
Y. Y. Tang ◽  
...  
Keyword(s):  
High Risk ◽  
Symptom Onset ◽  
Help Seeking ◽  
Cox Regression ◽  
Clinical Population ◽  
Psychotic Symptoms ◽  
Clinical High Risk ◽  
Chinese Sample ◽  
Over Time

Background.Chinese psychiatrists have gradually started to focus on those who are deemed to be at ‘clinical high-risk (CHR)’ for psychosis; however, it is still unknown how often those individuals identified as CHR from a different country background than previously studied would transition to psychosis. The objectives of this study are to examine baseline characteristics and the timing of symptom onset, help-seeking, or transition to psychosis over a 2-year period in China.Method.The presence of CHR was determined with the Structured Interview for Prodromal Syndromes (SIPS) at the participants' first visit to the mental health services. A total of 86 (of 117) CHR participants completed the clinical follow-up of at least 2 years (73.5%). Conversion was determined using the criteria of presence of psychotic symptoms (in SIPS). Analyses examined baseline demographic and clinical predictors of psychosis and trajectory of symptoms over time. Survival analysis (Kaplan–Meier) methods along with Log-rank tests were performed to illustrate the relationship of baseline data to either conversion or non-conversion over time. Cox regression was performed to identify baseline predictors of conversion by the 2-year follow-up.Results.In total 25 (29.1%) of 86 completers transitioned to a psychotic disorder over the course of follow-up. Among the CHR sample, the mean time between attenuated symptom onset and professional help-seeking was about 4 months on average, and converters developed fully psychotic symptoms about 12 months after symptom onset. Compared with those CHR participants whose risk syndromes remitted over the course of the study, converters had significantly longer delays (p = 0.029) for their first visit to a professional in search of help. At baseline assessment, the conversion subgroup was younger, had poorer functioning, higher total SIPS positive symptom scores, longer duration of untreated prodromal symptoms, and were more often given psychosis-related diagnoses and subsequently prescribed antipsychotics in the clinic.Conclusions.Chinese CHR identified primarily by a novel clinical screening approach had a 2-year transition rate comparable with those of specialised help-seeking samples world-wide. Early clinical intervention with this functionally deteriorating clinical population who are suffering from attenuated psychotic symptoms, is a next step in applying the CHR construct in China.

Natural history of longitudinally extensive transverse myelitis in 35 Hispanic patients with systemic lupus erythematosus: good short-term functional outcome and paradoxical increase in long-term mortality

Lupus ◽  
2018 ◽  
Vol 27 (8) ◽  
pp. 1279-1286 ◽  
Author(s):  
F D Flores-Silva ◽  
O Longoria-Lozano ◽  
D Aguirre-Villarreal ◽  
H Sentíes-Madrid ◽  
F Vega-Boada ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Functional Outcome ◽  
Lupus Erythematosus ◽  
Transverse Myelitis ◽  
Systemic Lupus ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome

Background and objective Acute transverse myelitis (TM) is an infrequent neurological complication of systemic lupus erythematosus (SLE). Short-term outcome varies widely between cohorts. Little is known about the epidemiology and long-term functional outcome of TM associated to SLE. Methods Patients with SLE and acute TM were identified during hospital admission, visits to the Emergency Room or the Neurology Outpatient Clinic. We evaluated ambispectively those patients with SLE presenting with clinical myelopathy and corroborated with spinal MRI. Cases were divided as partial (non-paralyzing) or complete (paralyzing). We determined long-term functional outcome as well as mortality in those patients with follow-up periods of at least five years. Results We identified 35 patients (partial, n = 15; complete, n = 20) in which complete clinical and imaging data were available (26 with follow-up ≥ 5 years). Patients with complete TM were significantly older than those with partial forms. Positive antiphospholipid antibodies were observed in 80% of patients, suggesting a possible mechanistical role. Surprisingly, functional recovery at one year was in general good; however, we observed a five-year mortality of 31% because of sepsis (in 10 cases) or pulmonary embolism (in one case). Conclusions Short-term outcome of SLE-related TM is generally good, and recurrence rate is low. However, we observed a long-term fatality rate of 31% for reasons unrelated to TM, suggesting that TM is a manifestation of severe immune dysregulation and a predictor of severity and mortality in patients with SLE.

scholarly journals Combined endoscopic and mini-open repair of chronic complete proximal hamstring tendon avulsion: a novel approach and short-term outcomes

2021 ◽  
Author(s):  
Shai Factor ◽  
Amal Khoury ◽  
Ran Atzmon ◽  
Matias Vidra ◽  
Eyal Amar ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Open Repair ◽  
Hamstring Tendon ◽  
Activity Level ◽  
Short Term ◽  
The Mean ◽  
Proximal Hamstring ◽  
Tendon Avulsion ◽  
Mini Open

  To evaluate the outcome of a novel, combined endoscopic and mini-open repair (CEMR) of a chronic complete retracted proximal hamstring tendon avulsion (PHA). A retrospective case series of a single-surgeon database for all patients, with a minimum of 1-year follow-up, who underwent CEMR between July 2015 and September 2019 was performed. Patients were evaluated for their functional outcome using the Perth Hamstring Assessment Tool (PHAT). At the latest follow-up, patients were evaluated for their muscle strength, subjective satisfaction and post-operative complications. Twelve patients who underwent endoscopic surgery for chronic PHA were identified, of which seven patients underwent CEMR. After exclusion of one patient from the study due to an open claim for health insurance, six patients (five males) with a mean age of 48 years (range 20–61 years) were evaluated. The mean time from injury to surgery was 12 months (range 2–43 months). At a mean follow-up of 28 months (range 12–55 months), the average PHAT score was 73 (range 70–80). The mean subjective activity level percentage improved from 34 (range 20–50) pre-surgery to 81 (range 75–90) post-surgery. The mean strength of the quadriceps, hamstring at 30°, and hamstring at 90° of the operated leg compared to the uninjured leg did not differ significantly. One patient underwent adhesiolysis 1 year after the index procedure for treatment of subcutaneous adhesions. CEMR is a viable and safe option for the treatment of chronic complete proximal hamstring tears, with good to excellent short-term functional outcome. Level of evidence: IV.

Twelve Years Later: The Vocational and Psychosocial Adjustment of Former Rehabilitation Clients

1980 ◽  
Vol 11 (3) ◽  
pp. 113-123
Author(s):  
Brian Bolton ◽  
Paul Rowland ◽  
Jeff Brookings ◽  
Daniel Cook ◽  
Paul Taperek ◽  
...  
Keyword(s):  
Psychosocial Adjustment ◽  
Vocational Training ◽  
Goal Attainment ◽  
Hot Springs ◽  
Work Status ◽  
Rehabilitation Center ◽  
Employment History ◽  
Case Vignettes ◽  
The Unemployed

A 12-year follow-up survey was conducted to assess the vocational and psychosocial adjustment of 225 former clients of the Hot Springs Rehabilitation Center (HSRC). Data collected at admission to and discharge from HSRC suggested that the clients were generally the more difficult rehabilitation cases and that most were only marginally successful in achieving their rehabilitation goals. Among the major findings of the follow-up survey were: (a) 56% of the ex-clients were working at follow-up and 73% had held some employment since leaving HSRC, (b) 49% of the ex-clients who were working at follow-up had been employed on the same job for 5 years or longer, (c) 60% of the working ex-clients believed that VR services were helpful in getting their jobs, (d) 73% of the former clients were not employed in occupations directly related to the vocational training that they had received at HSRC, (e) 47% of the unemployed ex-clients indicated that they had received no encouragement from their families in their efforts to become employed, (f) 60% of the unemployed ex-clients were receiving some form of public assistance, compared to 6% of the working ex-clients, and (g) counselors' ratings of psychosocial and vocational goal attainment and overall adjustment at HSRC were significant predictors of work status at follow-up and 12-year employment history. The article concludes with 10 brief case vignettes and a list of 35 significant findings.

scholarly journals Adverse clinical outcomes in people at clinical high-risk for psychosis related to altered interactions between hippocampal activity and glutamatergic function

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Paul Allen ◽  
Emily J. Hird ◽  
Natasza Orlov ◽  
Gemma Modinos ◽  
Matthijs Bossong ◽  
...  
Keyword(s):  
High Risk ◽  
Magnetic Resonance ◽  
Healthy Volunteers ◽  
Functional Outcome ◽  
Clinical Outcomes ◽  
Resonance Spectroscopy ◽  
Clinical High Risk ◽  
Hippocampal Activity ◽  
High Risk Cohort

AbstractPreclinical rodent models suggest that psychosis involves alterations in the activity and glutamatergic function in the hippocampus, driving dopamine activity through projections to the striatum. The extent to which this model applies to the onset of psychosis in clinical subjects is unclear. We assessed whether interactions between hippocampal glutamatergic function and activity/striatal connectivity are associated with adverse clinical outcomes in people at clinical high-risk (CHR) for psychosis. We measured functional Magnetic Resonance Imaging of hippocampal activation/connectivity, and 1H-Magnetic Resonance Spectroscopy of hippocampal glutamatergic metabolites in 75 CHR participants and 31 healthy volunteers. At follow-up, 12 CHR participants had transitioned to psychosis and 63 had not. Within the clinical high-risk cohort, at follow-up, 35 and 17 participants had a poor or a good functional outcome, respectively. The onset of psychosis (ppeakFWE = 0.003, t = 4.4, z = 4.19) and a poor functional outcome (ppeakFWE < 0.001, t = 5.52, z = 4.81 and ppeakFWE < 0.001, t = 5.25, z = 4.62) were associated with a negative correlation between the hippocampal activation and hippocampal Glx concentration at baseline. In addition, there was a negative association between hippocampal Glx concentration and hippocampo-striatal connectivity (ppeakFWE = 0.016, t = 3.73, z = 3.39, ppeakFWE = 0.014, t = 3.78, z = 3.42, ppeakFWE = 0.011, t = 4.45, z = 3.91, ppeakFWE = 0.003, t = 4.92, z = 4.23) in the total CHR sample, not seen in healthy volunteers. As predicted by preclinical models, adverse clinical outcomes in people at risk for psychosis are associated with altered interactions between hippocampal activity and glutamatergic function.

scholarly journals Study on the functional outcome of fluoroscopically guided transforaminal epidural steroid injections in patients suffering from lumbar disc herniation

2017 ◽  
Vol 3 (3) ◽  
pp. 607
Author(s):  
S. Natarajan ◽  
Anjan Venkataraman Krishnamurthy ◽  
R. Kalanithi ◽  
M. D. Ilavarasan
Keyword(s):  
Functional Outcome ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Short Term ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Vas Score ◽  
Epidural Steroid

<p><strong>Background: </strong>Intervertebral disc herniation of the lumbar region is one of the common causes of acute low back ache and lower extremity pain. While multiple treatment modalities exist, the efficacy of the usage of a transforaminal steroid injection as a tool to either alleviate pain or delay surgery needs to be further evaluated. The aim of this study is to determine the functional outcome of patients suffering from lumbar disc herniation treated with fluroscopically-guided transforaminal epidural steroid injections.</p><p><strong>Methods:</strong> This is a prospective case study in which total of 43 patients were included in the study dating between August 2014 and July 2015. These patients were evaluated and identified with lumbar disc herniation, confirmed with a magnetic resonance imaging prior to the procedure. A pre-injection VAS score was taken. These patients were administered TFESI under fluoroscopic guidance using 2ml of 40mg of Methylprednisolone with 1 ml of 2% xylocaine. They were then evaluated during follow up at 2 weeks, 6 weeks, 12 weeks, and 6 months. Their pain outcome was evaluated using the VAS (visual analog scale) scores and functional outcome was evaluated using Oswestry disability index (ODI).</p><p><strong>Results:</strong> All patients showed significant improvement in the VAS score during their regular follow up when compared to their pre injection levels. Patient satisfaction was the high at 2 weeks post operatively slightly declining over time. 3 patients underwent surgery during the follow up period. The ODI scores also showed significant improvements when compared to the pre injection scores at all follow up periods</p><p><strong>Conclusions: </strong>TFESI provides significant short-term pain relief in patients suffering from a single level lumbar herniated disc and is a viable, effective short-term analgesic tool to address pain and may retard an early surgical intervention.</p>

A STUDY ON OUTCOME OF SURGICAL TREATMENT OF COMPOUND TIBIA FRACTURES BY INTRAMEDULLARY NAILING AFTER PRELIMINARY EXTERNAL FIXATION – SHORT TERM RETROSPECTIVE AND PROSPECTIVE ANALYSIS

2021 ◽  
pp. 19-21
Author(s):  
Suresh Kumar Thirugnanam ◽  
Sudhakar Ramasamy
Keyword(s):  
Surgical Treatment ◽  
Functional Outcome ◽  
Intramedullary Nailing ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Prospective Analysis ◽  
Short Term ◽  
Tibia Fractures ◽  
Grade Iii

About 23% of all tibial fractures are open and most of these are Gustilo grade III. This study was done to evaluate the functional outcome of surgical treatment of compound tibia fractures by intramedullary nailing after preliminary external xation as a short term retrospective and prospective analysis. From February 2012 to November 2013, a short term retrospective and prospective analysis was done in The Institute of Orthopedics & Traumatology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai. We did secondary interlocking nailing after preliminary external xation for grade II to grade III B open tibia fractures in 31 patients for 31 fractures (Box 1 shows the inclusion and exclusion criteria). Out of these 31 patients, we lost follow-up of 4 patients and analyzed the results with the average follow-up of 12 months and minimum follow up of 5 months. Data was tabulated and analysed using Microsoft excel 2003. Functional outcome of secondary intra medullary nailing after external xation was far better than in primary interlocking with primary closure in our institution. Although the supercial infection is there and there is delay in denitive procedure in the management of compound fractures, this can be improved by early surgical intervention, timely secondary procedures and accurate assessment of soft tissue injury. The nal outcome is mainly depends on the age of the patient, time of admission since injury, type of injury.

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