Finnish Psychotherapy Quality Register: rationale, development, and baseline results.

BACKGROUND: The push to systematically follow treatment outcomes in psychotherapies to improve health care is increasing worldwide. To manage psychotherapeutic services and facilitate tailoring of therapy according to feedback a comprehensive and feasible data system is needed. AIMS: To describe the Finnish Psychotherapy Quality Register (FPQR), a comprehensive database on availability, quality, and outcomes of psychotherapies. METHODS: We describe the development of the FPQR and outcome for outsourced psychotherapies for adults in Helsinki and Uusimaa hospital district (HUS). Symptom severity and functioning are measured with validated measures (e.g. CORE-OM, PHQ-9, OASIS, AUDIT, and SOFAS). Questionnaires on therapeutic alliance, risks, methods, and goals are gathered from patients and psychotherapist. RESULTS: During 2018-2021, the FPQR included baseline data for 7274 unique patients and 336 psychotherapists. Response rate of measures was 85-98%. The use of the register was mandatory for the outsourced therapist of the hospital districts, and the patients were strongly recommended to fulfill the questionnaires. We report outcome for three groups of patients (n = 1844) with final/midterm data. The effect sizes for long psychotherapy (Hedge's g = 0.65 of SOFAS) were smaller than those for short psychotherapy (g = 0.75-0.91). Within three months of referral, 26-60% entered treatment depending on short- or long-term therapy. CONCLUSION: The FPQR forms a novel rich database with commensurate data on availability and outcomes of outsourced psychotherapies. It may serve as a basis for a national comprehensive follow-up system of psychosocial treatments. The Finnish system seems to refer patients with milder symptoms to more intensive treatments and achieve poorer results compared to the IAPT model in UK, Norway, or Australia.

Bidirectional pathways between psychosocial risk factors and paranoid ideation in a general nonclinical population.

We investigated (a) whether psychosocial factors (experienced stress, anticipatory worry, social detachment, sleeping disturbances, alcohol use) predict the course of paranoid ideation between the ages of 24 to 50 years and (b) whether the predictive relationships are more likely to proceed from the psychosocial factors to paranoid ideation, or vice versa. The participants (N = 1534-1553) came from the population-based Young Finns study. Paranoid ideation and psychosocial factors were assessed by reliable self-report questionnaires in 2001, 2007, and 2011/2012. The data were analyzed using growth curve and structural equation models. High experienced stress, anticipatory worry, social detachment, frequent sleeping disturbances, and frequent alcohol use predicted more paranoid ideation. More risk factors predicted increasing paranoid ideation. There were bidirectional predictive relationships of paranoid ideation with experienced stress, anticipatory worry, social detachment, and sleeping disturbances. The link between alcohol use and paranoid ideation was only correlative. In conclusion, paranoid ideation increases by reciprocal interactions with stress, worry, social detachment, and sleeping disturbances. The findings support the threat-anticipation model of paranoid ideation, providing important implications for treatment of paranoia.

Adolescent psychiatric outpatient care rapidly switched to remote visits during the COVID-19 pandemic.

BACKGROUND: The COVID-19-pandemic and especially the physical distancing measures drastically changed the conditions for providing outpatient care in adolescent psychiatry. METHODS: We investigated the outpatient services of adolescent psychiatry in the Helsinki University Hospital (HUH) from 1/1/2015 until 12/31/2020. We retrieved data from the in-house data software on the number of visits in total and categorized as in-person or remote visits, and analysed the data on a weekly basis. We further analysed these variables grouped according to the psychiatric diagnoses coded for visits. Data on the number of patients and on referrals from other health care providers were available on a monthly basis. We investigated the data descriptively and with a time-series analysis comparing the pre-pandemic period to the period of the COVID-19 pandemic. RESULTS: The total number of visits decreased slightly at the early stage of the COVID-19 pandemic in Spring 2020. Remote visits sharply increased starting in 3/2020 and remained at a high level compared with previous years. In-person visits decreased in Spring 2020, but gradually increased afterwards. The number of patients transiently fell in Spring 2020. CONCLUSIONS: Rapid switch to remote visits in outpatient care of adolescent psychiatry made it possible to avoid a drastic drop in the number of visits despite the physical distancing measures during the COVID-19 pandemic.

Specificity and sensitivity of the Beck Hopelessness Scale for suicidal ideation among adolescents entering early intervention service.

Previous studies have shown an association between hopelessness and suicidal behaviour in clinical populations. The aim of the study was to investigate sensitivity, specificity, and predictive validity of the Beck Hopelessness Scale (BHS) for suicidal ideation in adolescents who show early risk signs on the psychiatric disorder continuum. Three-hundred and two help-seeking adolescents (mean age = 15.5 years) who were entering an early intervention team at Helsinki University Central Hospital, Finland, completed questionnaires of BHS and suicidal ideation, derived from Beck Depression Inventory (BDI-II). Results suggest that a BHS cut-off score ≥8 (sensitivity = 0.70, specificity = 0.76) or cut-off score ≥9 (sensitivity = 0.63, specificity = 0.80) may be useful to detect suicidal ideation with BHS in help-seeking adolescents population. Results remain mainly the same in a separate analysis with adolescents at risk for psychosis. The results support previous cut-off points for BHS in identification of suicidal ideation. The results suggest also that lower cut-off scores may be useful in sense of sensitivity, especially in clinical settings.

Exploratory factor analysis of a 16D Health-Related Quality of Life instrument with adolescents seeking help for early psychiatric symptoms.

BACKGROUND: Health-related quality of life (HRQoL) is a widely studied phenomenon in health care. This study aimed to identify which factors can be extracted from a generic 16-dimension (16D) HRQoL instrument in a sample of adolescents seeking help for early psychiatric symptoms. METHODS: Data were collected at the Helsinki University Central Hospital (HUCH), Finland, by an early intervention team. In total, 394 help-seeking adolescents (mean age 15.3 years, SD 2.14 years, 183 boys and 211 girls) completed a 16D HRQoL questionnaire. RESULTS: Exploratory factor analysis (generalized least squares method, promax rotation) identified four factors in the 16D instrument. The first factor of "psychophysiological health" included the dimensions of vitality, breathing, distress, sleeping, physical appearance, mental functioning and depression. The second factor, "physical and social health", consisted of the items discomfort and symptoms, friends and elimination. The items hearing, eating and speech were loaded on factor three, "health in somatosensory functioning". Moreover, the single item of school and hobbies was loaded on factor four, "health in functioning ability". However, the items of vision and mobility were not loaded on any factor. Since the 16D instrument was originally designed for 11-15-year-old adolescents, analysis was repeated using a subsample of this age group (n = 245). CONCLUSIONS: The results here suggest that the 16D instrument consists of four factors and forms its own latent variable structure in this specific sample of adolescents seeking help for early psychiatric symptoms. However, items such as vision, mobility and school and hobbies should be interpreted with caution as a part of the factor structure of a 16D instrument among this population.

[Clinical significance of psychotic-like symptoms in youth]. / Nuorten psykoottistyyppisten oireiden kliiininen merkitys.

Symptoms of the psychotic type are relatively common in young persons, but seldom result in the development of an actual psychotic disorder. Psychotic-like symptoms in the young are, however, associated with more severe psychiatric symptoms and a less favorable prognosis, whereby their identification is important in psychiatric treatment. A symptom-oriented approach is important in the treatment: instead of the possible risk of psychosis, focus will be on the actual situation, taking the total symptom picture and the person's life situation into consideration. Cognitive psychotherapy is the recommended first-line treatment for psychotic-like symptoms.

Changes in depression, anxiety and hopelessness symptoms during family- and community-oriented intervention for help-seeking adolescents and adolescents at risk of psychosis.

BACKGROUND: Little is known about how symptoms are changed in adolescents who receive treatment in an early detection and intervention service. AIMS: The aims of the present research were to study change in depression, anxiety and hopelessness symptoms in a sample of help-seeking adolescents who participated in a community- and family-oriented early intervention programme. METHODS: The data was collected in Helsinki University Central Hospital (HUCH), Finland, by the JERI (Jorvi Early psychosis Recognition and Intervention) early intervention team; 85 help-seeking adolescents filled questionnaires of anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory II) and hopelessness (Beck Hopelessness Scale). The PROD screen was used to assess risk of psychosis. RESULTS: Paired samples t-test of anxiety, depression and hopelessness showed statistically significant improvement on all scales (P < 0.001) in all participants (n = 85) between baseline and the end of intervention. Improvement was significant on scales of anxiety (P = 0.004), depression (P < 0.001) and hopelessness (P < 0.001) for participants at risk of psychosis (n = 34). Effect sizes were from medium to large for changes. After the treatment, of all participants, 68.8% were at a remission level of symptoms in anxiety, 84.7% in symptoms of depression and 88.2% in symptoms of hopelessness. Of sub-group of participants at risk of psychosis, 58.8% were at a remission level of symptoms in anxiety, 76.4% in symptoms of depression and 79.4% in symptoms of hopelessness. CONCLUSIONS: Present results suggest that there is both statistically and clinically remarkable improvement in anxiety, depression and hopelessness symptoms after the intervention. These findings should be considered in the psychiatric care of help-seeking adolescents and adolescents at risk of psychosis.

Anxiety symptoms in adolescents at risk for psychosis: a comparison among help seekers.

BACKGROUND: Several studies have reported on how anxiety disorders and anxiety symptoms are already present before the onset of psychosis. However, anxiety disorders are typically studied in these studies at diagnosis-level. The aim of present study was to investigate the profile of anxiety symptoms in subjects at risk of developing psychosis and to compare the anxiety profile with those who are not at risk. METHOD: Data were collected at Helsinki University Central Hospital (HUCH) by an early detection and intervention team. Of 185 help-seeking respondents, between 12 and 18 years of age, 59 adolescents were classified as being at risk of psychosis and 126 as not being at risk via an interview conducted by a validated at-risk assessment tool (PROD). Anxiety was measured using the Beck Anxiety Inventory (BAI). RESULTS: The anxiety total sum score was higher in the at-risk group for psychosis (mean 8.33 vs. 13.34, p = .000). Both subfactors of the anxiety scale, cognitive anxiety (p = .000) and somatic anxiety (p = .000), differed significantly by risk status. After using the Bonferroni correction for multiple analysis, items of relax (p = .000), nervous (p = .002), losing control (p = .000) and faint (p = .002) had statistically significant higher mean scores in the group at risk of psychosis. In logistic regression analysis, being female (p = .015) and the subfactor relating to cognitive anxiety (p = .044) significantly explained the at-risk status for psychosis. CONCLUSIONS: Adolescents at risk for psychosis have a higher level of anxiety compared with other help-seeking adolescents. These results should be considered in clinical practice.

Adolescents at risk of psychosis have higher level of hopelessness than adolescents not at risk of psychosis.

BACKGROUND: Hopelessness has been a widely studied phenomenon in psychotic disorders. However, previous evidence of hopelessness in at-risk state of psychosis is lacking. The primary aim of the present study was to investigate associations between at-risk state of psychosis and the level of hopelessness, the secondary aim being to investigate, at item-level, hopelessness differences in hopelessness profile of adolescents at risk of psychosis. METHODS: Hopelessness was assessed with the Beck Hopelessness Scale (BHS) and risk of psychosis with the PROD screen by an early detection team at the Helsinki University Central Hospital in a sample of 200 help-seeking adolescents between 11 and 22 years of age. Of them, 66 were classified as belonging to the at-risk of psychosis group and 134 to the not-at-risk of psychosis group. RESULTS: The at-risk group scored higher in total sum scores of hopelessness than the not-at-risk group (9.15 vs. 6.63, P = 0.002). In an additional analysis of the BHS, the sub-item "I have great faith in the future" (P < 0.001) differed by risk status of psychosis after correction for multiple analysis. In a logistic regression analysis, BHS subfactor III (sum scores of items "I can't imagine what my life would be like in 10 years" and "I don't expect to get what I really want") explained (P = 0.047) the at-risk status of psychosis after age, gender and other BHS subfactors had been adjusted for. CONCLUSIONS: Adolescents at risk of psychosis have higher hopelessness than other help-seekers. In light of a heightened possibility of suicidal behaviour, psychiatric care should pay attention to these findings.

Depression symptoms in help-seeking adolescents: a comparison between adolescents at-risk for psychosis and other help-seekers.

BACKGROUND: Depression and psychosis are severe diseases with onset in adolescence. AIMS: The aim of this study was to investigate the association between an at-risk status of psychosis and depression symptoms in adolescents. METHOD: The data were collected by an early intervention team in Finland. The PROD screen was used to assess the risk of psychosis, and Beck Depression Inventory-II was used as a measurement to assess the level of depression symptoms. Of 203 help-seeking respondents, 66 were classified as at-risk for psychosis, and 137 respondents were other help-seekers. The mean age of the subjects was 15.3 years. RESULTS: Subjects at-risk had significantly poorer scores in total scores for depression (p < 0.001), and in an item-by-item analysis, the subjects at-risk had poorer scores for sadness (p < 0.001), past failure (p = 0.001), suicidal thoughts (p < 0.001), crying (p = 0.002), agitation (p = 0.001), loss of energy (p = 0.002) and concentration difficulty (p < 0.001). In a logistic regression analysis of items that differed by risk status for psychosis, item of concentration difficulty (p = 0.038) explained the at-risk status after adjustment for sex. CONCLUSIONS: The present results suggest that subjects that are at-risk for psychosis have more depression symptoms than other help-seekers. This should be considered in the psychiatric care of adolescents.

Changes in health-related quality of life and functioning ability in help-seeking adolescents and adolescents at heightened risk of developing psychosis during family- and community-oriented intervention model.

Abstract Objective. Early intervention has been shown to benefit people at-risk for psychosis, but knowledge about how early intervention benefits all help-seeking adolescents is lacking. The aim of the present study was to study change in health-related quality of life (QoL) and functioning ability in help-seeking adolescents who participate in a community- and family-oriented early intervention program. Methods. The data was collected in Finland by an early-intervention team. Ninety help-seeking adolescents between 12 and 21 years of age filled out a questionnaire on QoL (16D) and functioning ability (GAF), which was assessed by workers at the beginning and at the end of the intervention. A PROD screen was used to assess heightened risk of developing psychosis. Results. QoL and functioning ability showed significant differences (p < 0.001) between the beginning and the end of the intervention, as well in a subgroup of participants at heightened risk of developing psychosis (QoL, p = 0.008; GAF, p < 0.001: n = 35). 35.6% improved over the clinical cut-off point in functioning ability and 48.6% of the subjects at-risk. 53.3% reached clinically significant improvement in QoL and 54.2% of the subjects at heightened risk of developing psychosis. Conclusions. The results suggest that there is both statistically and clinically remarkable improvement in QoL and functioning ability after a need-adapted, family- and community-oriented intervention.

Factor and network analysis of psychosis-like experiences and depressive symptoms in a sample of Finnish adolescents entering psychiatric services.

AIM: Psychosis-Like Experiences (PLEs) and depressive symptoms are correlated in clinical adolescent populations. However, symptom-level associations between the two phenomena are not clear. METHODS: We analysed factor structures of a PLE instrument, the Prodromal Questionnaire-Brief (PQ-B), based on dimensions of positive symptoms of schizophrenia, and a depression measurement instrument, the Beck Depression Inventory (BDI-21A) and performed a network analysis of item-level associations between the two measures. The sample consisted of 417 adolescents (range 13-18 years of age, mean 14.9 years, 72.4% females) entering secondary psychiatric services at Helsinki metropolitan area, Finland. RESULTS: Confirmatory factor analysis resulted in adequately fitting 2-factor solution, one for PQ-B and one for BDI-21, with a strong correlation coefficient of 0.605 between the two factors. In the network analysis, PQ-B and BDI-21 both formed their own clusters, and two significant pathways were estimated between PQ-B and BDI-21 clusters: 1. the association between paranoid thinking and distorted body image, and 2. the association between somatic preoccupation and worry about problems of one's mind. CONCLUSIONS: Even though on a general, factor level, PLEs and depressive symptoms were strongly correlated, unique associations between symptoms of the two constructs were sparse. These findings should be considered in the psychiatric assessment and in the care of adolescents.

Poor functioning ability is associated with high risk of developing psychosis in adolescents.

BACKGROUND: While functioning ability, quality of life (QoL) and depression are widely studied phenomena in schizophrenia, little is known about functioning ability, QoL and depression, especially among adolescents at high risk of developing first-episode psychosis. AIM: To investigate associations between high risk of developing psychosis and functioning ability, depression and QoL among adolescents. METHODS: The data was collected by an early intervention team in Espoo, Finland, between 1 January 2007 and 31 May 2008. Subjects at high risk of developing psychosis were compared with subjects not at high risk in terms of functioning ability (GAF), QoL (16D) and depressive symptoms (RBDI) in a cross-sectional setting. The study was conducted with 80 adolescents (mean age 14.7, range 12-18 years). RESULTS: Those at high risk of developing psychosis had significantly lower and poorer scores in functioning ability (53.4 vs. 58.4, P=0.006), had higher and poorer scores in QoL (10.81 vs. 7.05, P=0.002) and higher and poorer scores in depression (8.95 vs. 4.76, P=0.001) than those who did not meet the criteria of being at high risk of developing psychosis. Poorer functioning ability independently explained being at high risk of developing psychosis at a statistically significant level (P=0.021) in a logistic regression analysis after age, gender, depression and QoL were adjusted for. CONCLUSIONS: Poor functioning ability seems to be associated with high risk of developing psychosis among adolescents.

Structural and functional alterations in the brain gray matter among first-degree relatives of schizophrenia patients: A multimodal meta-analysis of fMRI and VBM studies.

OBJECTIVE: We conducted a multimodal coordinate-based meta-analysis (CBMA) to investigate structural and functional brain alterations in first-degree relatives of schizophrenia patients (FRs). METHODS: We conducted a systematic literature search from electronic databases to find studies that examined differences between FRs and healthy controls using whole-brain functional magnetic resonance imaging (fMRI) or voxel-based morphometry (VBM). A CBMA of 30 fMRI (754 FRs; 959 controls) and 11 VBM (885 FRs; 775 controls) datasets were conducted using the anisotropic effect-size version of signed differential mapping. Further, we conducted separate meta-analyses about functional alterations in different cognitive tasks: social cognition, executive functioning, working memory, and inhibitory control. RESULTS: FRs showed higher fMRI activation in the right frontal gyrus during cognitive tasks than healthy controls. In VBM studies, there were no differences in gray matter density between FRs and healthy controls. Furthermore, multi-modal meta-analysis obtained no differences between FRs and healthy controls. By utilizing the BrainMap database, we showed that the brain region which showed functional alterations in FRs (i) overlapped only slightly with the brain regions that were affected in the meta-analysis of schizophrenia patients and (ii) correlated positively with the brain regions that exhibited increased activity during cognitive tasks in healthy individuals. CONCLUSIONS: Based on this meta-analysis, FRs may exhibit only minor functional alterations in the brain during cognitive tasks, and the alterations are much more restricted and only slightly overlapping with the regions that are affected in schizophrenia patients. The familial risk did not relate to structural alterations in the gray matter.

Association of hostility with sleep duration and sleep disturbances in an employee population.

BACKGROUND: Sleep disturbances are common among the general population, and hostile persons have been proposed to be at greater risk of several serious health problems and diseases. PURPOSE: This study examined the relationships between hostility, sleep disturbances, and sleep duration in a large non-clinical sample of 5,433 employees working in 12 Finnish hospitals. METHOD: Data were collected by questionnaire surveys in 1998 and 2000. RESULTS: Higher hostility was cross-sectionally associated with increased sleep disturbances but not with sleep duration after adjustment for gender, age, marital status, education, shift work, smoking, alcohol consumption, physical activity, body mass index, psychiatric morbidity, and somatic disease. A stratified analysis distinguishing individuals with stable hostility across the two measurements and those with transient hostility (> 0.5 SD difference between measurements) replicated the association with increased sleep disturbance in both groups, but among those with transient hostility, there additionally was a cross-sectional association between higher hostility and shorter sleep duration. CONCLUSION: Our evidence suggests that hostility is an independent risk factor for sleep disturbances and that transient hostility may also predispose shorter sleep duration. However, the effect sizes for all these associations were small, suggesting limited clinical significance for our findings.

Community-oriented family-based intervention superior to standard treatment in improving depression, hopelessness and functioning among adolescents with any psychosis-risk symptoms.

The aim of the present study was to compare change in functioning, affective symptoms and level of psychosis-risk symptoms in symptomatic adolescents who were treated either in an early intervention programme based on a need-adapted Family- and Community-orientated integrative Treatment Model (FCTM) or in standard adolescent psychiatric treatment (Treatment As Usual, TAU). 28 pairs were matched by length of follow-up, gender, age, and baseline functioning. At one year after the start of treatment, the matched groups were compared on change in functioning (GAF-M), five psychosis-risk dimensions of the Structured Interview for Psychosis-Risk Syndromes (SIPS), and self-reported anxiety, depression, and hopelessness symptoms (BAI, BDI-II, BHS). FCTM was more effective in improving functioning (20% vs. 6% improvement on GAF-M), as well as self-reported depression (53% vs. 14% improvement on BDI-II) and hopelessness (41% vs. 3% improvement on BHS). However, for psychosis-risk symptoms and anxiety symptoms, effectiveness differences between treatment models did not reach statistical significance. To conclude, in the present study, we found greater improvement in functioning and self-reported depression and hopelessness among adolescents who received a need-adapted Family- and Community-orientated integrative Treatment than among those who were treated in standard adolescent psychiatry.

Discrepancy between self-reported and interviewed psychosis risk symptoms: auditory distortions are the most reliably reported symptom by self-report.

AIM: In the recent literature, there has been growing interest in assessment methods for detecting increased risk of developing psychosis. Self-report methods are popular but may lead to different results compared to clinical interviews. METHODS: The difference in psychosis risk scores was tested between self-reported psychosis risk symptoms (PROD-SR) and self-reported symptoms additionally confirmed by interview (PROD-SR + I). The symptom categories were derived from 12 common psychosis risk symptoms included in the PROD screening instrument. The data were collected by questionnaires and interviews conducted with 395 adolescents (mean age 15.3 years) in an early intervention and detection team, JERI, at Helsinki University Central Hospital, Finland. RESULTS: The results show a significant difference between the PROD-SR risk symptom sum scores and the PROD-SR + I risk symptom sum scores (N = 395; Z = -15.123; P < 0.001). In an item-by-item analysis, the item 'Disorders in connection with hearing' had the strongest kappa value (0.827) agreement between an interviewed and self-report psychosis risk item. Agreement in most items remained between slight and substantial (kappa values from 0.082 to 0.649). CONCLUSIONS: The results suggest that there is a significant difference between psychosis risk symptom responses collected by self-report and self-report responses which are additionally confirmed by interview. Auditory disorders are the most reliably reported item with self-report.

Early signs of worry: psychosis risk symptom visual distortions are independently associated with suicidal ideation.

Previous studies have shown an association between suicidal behavior and schizophrenia. However, little is known about this association in those with psychotic experiences and symptoms that do not meet the criteria for full psychosis. The aim of the study was to investigate how psychosis risk symptoms are associated with suicidal ideation. Three-hundred and nine help-seeking adolescents (mean age 15.5 years) who were screened by an early intervention and detection team JERI in Helsinki University Central Hospital, Finland, were interviewed and asked to complete questionnaires of psychosis risk symptoms, suicidal ideation and depression. Psychosis risk symptoms were assessed by self-report and confirmed by interview with questions from PROD-screen, depression was measured with BDI-II questionnaire and suicidal ideation was derived from BDI-II questionnaire. In a logistic regression analysis psychosis risk symptom visual distortions explained independently (OR 4.33; 95% CI 1.28-14.64) suicidal ideation when age, gender, depression and psychosis risk symptoms thought disorders, persecuting feelings and auditory distortions were controlled for. Results suggest that visual distortions are independently associated with suicidal ideation in young people. This finding should be taken into account in assessing help-seeking adolescents.

Lower functioning predicts identification of psychosis risk screening status in help-seeking adolescents.

AIM: There is some previous evidence suggesting that the risk state for psychosis is associated with decreased functioning ability, health-related quality of life (QoL), anxiety and depression. The aim of this study is to identify which factors predict psychosis risk screening status. METHODS: The data were collected in Helsinki University Central Hospital, Finland, by an early intervention team. One hundred eighty-one help-seeking adolescents (mean age 15.3 years) completed questionnaires of QoL (16D), alcohol consumption (Alcohol Use Disorders Identification Test), anxiety (Beck Anxiety Inventory), hopelessness (BBeck Hopelessness Scale) and depression (Beck Depression Inventory II). Functioning ability was assessed by the Global Assessment of Functioning, whereas the PROD-screen was used to interview and assess risk symptoms for psychosis. RESULTS: In a logistic regression analysis, a lower functioning ability explained independently (P = 0.006) psychosis risk screening status after age, gender, alcohol consumption, QoL, anxiety, hopelessness and depression symptoms were adjusted. CONCLUSIONS: The present results suggest that lower functioning ability is associated independently with psychosis risk screening status. Hence, therapeutic input for those at risk should focus upon improving functioning.

Health-related quality of life among adolescents: a comparison between subjects at risk for psychosis and other help seekers.

AIM: Schizophrenia is a severe illness associated with poor health-related quality of life (HRQoL), and there is some evidence that a risk state for psychosis is associated with decreased HRQoL. The aim of the present study was to investigate group differences in HRQoL in help seekers at risk for psychosis and not at risk for psychosis. METHODS: The data were collected by a Finnish early detection and intervention team at Helsinki University Central Hospital. A total of 202 help-seeking adolescents (110 girls, 92 boys; 11-22 years of age) were assessed with a PROD screen and HRQoL scale of 16D. RESULTS: As the main result, subjects at risk for psychosis had a poorer HRQoL index than other help seekers (P < 0.001). An additional analysis of sub-items for the HRQoL at-risk group had poorer mean scores at a statistically significant level after Bonferroni correction for multiple tests in the following sub-items: vitality (P = 0.016), distress (P = 0.016), physical appearance (P < 0.001), school and hobbies (P = 0.016), friends (P = 0.048), mental function (P < 0.001) and depression (P < 0.001). In a logistic regression analysis of sub-items of the HRQoL scale, lower scores in the sub-item of mental function independently explained the at-risk status for psychosis (P = 0.009). CONCLUSIONS: Adolescents at risk for psychosis have a poorer HRQoL index than other help seekers and they also differ in several sub-items, particularly in the lower scores in mental function. In the future, these findings should be considered in the care of adolescents at risk for psychosis.