Association of Adverse Outcomes, Emotion Processing and its Neural Substrate in Individuals at Clinical High Risk for Psychosis

Gemma Modinos, Matthew Kempton , Stefania Tognin, Mathilde Antoniades, Matilda Azis, Paul Allen, Stefan Borgwandt, P.D. McGorry, Lucia R. Valmaggia, Philip McGuire

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Importance: The development of adverse clinical outcomes in patients with psychosis has been associated with behavioral and neuroanatomical deficits related to emotional processing. Objective: To examine the association between alterations in emotional processing and regional grey matter volumes in individuals at clinical high-risk (CHR) for psychosis, and their relationship with subsequent clinical outcomes.Design: Prospective naturalistic study with clinical follow-up at 12 months, conducted from July 2010 to August 2016.Setting: Nine psychosis early detection centers.Participants: 213 CHR individuals and 52 healthy controls.Main Measures & Outcomes: Emotion recognition was assessed using the Degraded Facial Affect Recognition Task. MRI data were acquired on 3T scanners and grey matter volume was measured in regions of interest (medial prefrontal cortex, amygdala, hippocampus, insula). Clinical outcomes at 12 months were assessed in terms of transition to psychosis (CAARMS criteria) and the level of overall functioning (Global Assessment of Function [GAF] scale).Results: A total of 213 CHR individuals (mean [SD] age, 22.9 [4.7] years; 105 [49.3%] female) and 52 healthy controls (mean [SD] age, 23.3 [4.0] years; 25 [48.1%] female) were included in the study at baseline. At follow-up, 44 CHR individuals had developed psychosis (mean [SD] age, 22.6 [4.7] years; 19 [43.2%] female) while 169 had not (mean [SD] age, 23.0 [4.7] years; 86 [50.9%] female). Of the CHR individuals re-interviewed with the GAF, 39 showed “good” overall functioning (GAF≥65) (mean [SD] age, 23.5 [4.7] years; 19 [48.7%] female) whereas 91 had “poor” overall functioning (GAF<65) (mean [SD] age, 23.1 [5.0] years; 41 [45.1%] female). Within the CHR sample, better anger recognition at baseline was associated with poorer functional outcome (OR=0.88, 95% CI=0.78-0.99, P=0.03). In CHR individuals with a good functional outcome, there were stronger positive associations between anger recognition and hippocampal volume (Z=3.91, P=0.02 FWE), and between fear recognition and medial prefrontal volume (Z=3.60, P=0.02 FWE) than in participants with a poor outcome. The onset of psychosis was not associated with baseline emotion recognition performance, and there was no difference in the relationship between performance and regional grey matter volumes in CHR individuals who did or did not develop psychosis. Conclusions and Relevance: Poor functional outcome in CHR individuals was associated with baseline abnormalities in the recognition of negative emotion. This has potential implications for the stratification of CHR individuals according to subsequent outcomes, and suggests that functional outcomes might be improved by interventions that target socio-emotional processing. 
Original languageEnglish
Publication statusPublished - 13 Nov 2019

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