Browsing by Author "Ärmänen, Anna"

Objectives. Functioning impairments as an outcome for severe mental disorders have been well established. There is also growing evidence for early functioning impairment being a vulnerability marker for psychotic disorders. Recent findings suggest that especially early social functioning impairment may predict later psychotic disorders. However previous studies are few and they are limited to pre-selected psychosis risk samples. In addition, little is known about early functioning in other severe mental disorders. The aim of this study is to determine the level of functioning in adolescents at entry to general psychiatric services and to examine whether early functioning impairment predicts later psychosis or psychiatric hospitalizations directly, and when controlling for the effect of psychosis risk symptoms. Methods. This study is a part of the larger Helsinki Prodromal Study conducted in the National Institute for Health and Welfare. The sample consists of 154 treatment-seeking adolescents aged 15–18 years, recruited at the first visit to psychiatric services in Helsinki. Semi-structured psychiatric interviews were conducted for all participants at baseline. Functioning was assessed with validated and reliable functioning measures for social (Global functioning: social) and role functioning (Global functioning: role) and an experimental functioning measure for psychological functioning (Global functioning: psychological). Information about hospitalizations was extracted from the Finnish hospital discharge register during a 2.8–8.9 year follow-up until the end of 2011. A Cox regression survival analysis was used to examine whether functioning domains predicted later hospitalization for psychosis or psychiatric hospitalizations overall. Positive and general psychosis risk symptoms as well as psychosis risk status were controlled for the analyses. Results and conclusions. The functioning of adolescents at entry to psychiatric services was mildly impaired and the impairment was greater for individuals in psychosis risk and those with a mental disorder diagnosis. 7 transitions to psychosis and 26 psychiatric hospital admissions emerged during the follow-up. The level of psychological functioning was the only significant predictor of increased risk of hospitalizations whereas the level of positive symptoms was the only significant predictor of increased risk of psychosis. Neither social nor role functioning predicted the outcomes. The results concerning social functioning are in contrast with previous finding, which may be attributable to the low incidence of psychosis in the sample or the treatment received by the participants. Overall the results emphasize the importance of interventions for early symptoms to prevent these severe outcomes.