Background and hypothesis: Around 20% of people at clinical high-risk (CHR) for psychosis later develop a psychotic disorder, but it is difficult to predict who this will be. We assessed the incidence of hearing speech (termed speech illusions) in noise in CHR participants and examined whether this was associated with adverse clinical outcomes. Study design: At baseline, 344 CHR participants and 67 healthy controls (HC) were presented with a computerised white noise task and asked whether they heard speech, and whether speech was neutral, affective or whether they were uncertain about its valence. After two years, we assessed whether participants transitioned to psychosis, or remitted from the CHR state, and their functioning. Study results: CHR participants had a lower sensitivity on the task. Logistic regression revealed that a bias towards hearing targets in stimuli was associated with remission status (OR=.21, p=.042). Conversely, hearing speech illusions with uncertain valence at baseline was associated with reduced likelihood of remission (OR=7.72. p=.007). When we assessed only participants who did not take antipsychotic medication at baseline, the association between hearing speech illusions with uncertain valence at baseline and remission likelihood remained (OR=7.61, p=.043) and this variable was additionally associated with a greater likelihood of transition to psychosis (OR=5.34, p=.029). Conclusions: In CHR individuals, a tendency to hear speech in noise, and uncertainty about the affective valence of this speech, is associated with adverse outcomes. This task could be used in a battery of cognitive markers to stratify CHR participants according to subsequent outcomes.
|Early online date||14 Dec 2022|
|Publication status||E-pub ahead of print - 14 Dec 2022|