Long-term outcome in adolescents at ultra-high risk for psychosis: A focus on resilience

Abstract

Since the introduction of ultra-high risk for psychosis (UHR) criteria 20 years ago, a large number of studies have investigated the mechanisms of disease onset and progression. However, with decreasing transition-to-psychosis rates and increasing numbers of individuals remitting from UHR symptoms, there is a recent increase of interest in studying individuals who remit from UHR criteria. Additionally, there is a call for studies focusing on functional outcomes. Research aims of this thesis therefore focused on studying long-term clinical and functional outcome of UHR individuals and exploring the relative value of neurocognitive, neurobiological (structural MRI) and clinical variables for predicting long-term outcome. Results show that UHR criteria are not specific to increased risk of psychosis but are rather associated with general psychopathology. This is supported by both clinical and neurobiological findings throughout this thesis. When replicated and fine-tuned in larger UHR cohorts, we believe structural imaging data may be useful for clinically relevant prediction of long-term outcome at the individual level. Second, our findings support the notion that UHR individuals may function poorly regardless of whether they develop psychosis. Prediction should therefore be aimed at long-term functional outcome and treatments aiming to improve functioning should be considered a priority for individuals in the UHR state.