What drives poor functioning in the at-risk mental state? A systematic review

Area of Science:

• Psychiatry
• Clinical Psychology
• Neuroscience

Background:

• The at-risk mental state (ARMS) traditionally focuses on psychosis transition.
• Growing evidence suggests significant functional impairment in ARMS individuals, irrespective of psychosis development.
• This review investigates factors associated with functional deficits in the ARMS population.

Purpose of the Study:

• To systematically review the literature on factors associated with or predicting functional impairment in individuals with an at-risk mental state (ARMS).
• To identify specific clinical and cognitive variables linked to functional outcomes in ARMS.

Main Methods:

• Comprehensive electronic database search (MEDLINE, PsycINFO, Embase) up to May 2014.
• Inclusion of original, peer-reviewed English language studies meeting validated ARMS criteria.
• Analysis of cross-sectional and longitudinal associations between variables and functioning measures.

Main Results:

• Seventy-two studies were included in the review.
• Negative symptoms and neurocognitive impairment were linked to poor functioning cross-sectionally.
• Longitudinal studies identified negative/disorganized symptoms, cognitive deficits, and baseline functioning as predictors of functional decline.
• Positive symptoms showed no association with functioning.

Conclusions:

• Negative and disorganized symptoms, alongside cognitive deficits, precede psychosis and are key risk factors for functional impairment in ARMS.
• This suggests a potential neurodevelopmental pathway for schizophrenia in a subset of ARMS individuals.
• Interventions prioritizing functional improvement are crucial for ARMS, on par with psychosis prevention.