100. Converging Evidence for Social Functioning Deficits as a Neurodevelopmental Risk Factor in High-Risk Youth

Background: Social functioning deficits are present prior to the onset of psychosis and predict psychosis conversion in high-risk youth (Cornblatt et al, 2015; Cannon et al, 2008). In addition, past research from the Recognition and Prevention (RAP) Program found that social skill deficits are lifelong traits related to poor functional outcome in general (Cornblatt et al, 2015; Carrion et al, 2013). This poster reassesses the implications of social skill deficits as a developmental trait by examining change in social functioning. Methods: Subjects include 88 clinical high risk (CHR) participants enrolled in Phase 1 of the RAP Program and 347 CHR participants enrolled in the North American Prodrome Longitudinal Study 2 (NAPLS2). Social functioning deficits were assessed with the Global Functioning: Social (GF:S) scale, an interview measure of social interactions rated from 1–10 with higher scores indicating better functioning (Cornblatt et al, 2007). Associations between GF:S scores and baseline demographics, SIPS attenuated positive and negative symptoms, and Axis I diagnoses were examined. Conversion to psychosis and functional outcome were assessed at follow up (RAP = 3 years, NAPLS2 = 2 years). CHR participants were divided according to whether their GF:S score improved, did not change, or declined over follow up. GF:S scores were also dichotomized into Good (GF:S ≥ 7) vs Poor (GF:S ≤ 6) functioning at baseline and follow up. Results: For the RAP sample, there were no significant differences between groups on demographic variables or SIPS symptoms. The Improver and No Change groups were significantly more likely to be diagnosed with Social Phobia compared to Decliners (Ps < .01). Similar results were found in the larger NAPLS2 sample for demographic variables, SIPS symptoms, and Axis I diagnoses (all ns). Significantly more Decliners in both samples converted to psychosis (RAP 32%, NAPLS2 36%) compared to the Improvers (RAP 10.5%, NAPLS2 10%; Ps ≤ .03). Decliners were also more likely to convert than the No Change (8%) group (RAP, P = .03; NAPLS, trend). In addition, No Change subjects were more likely to have poor functioning at baseline and outcome (RAP 72%, NAPLS2 51%). Conclusion: As expected, CHRs with decline in social functioning are at greatest risk for psychosis. In contrast, CHRs who improve over time are likely not at risk for either psychosis or functional disability. The remaining subjects display stable poor functioning, but are less likely to develop psychosis, suggesting their risk is for long term functional disability. Only one clinical variable, Social Phobia, differentiated groups, indicating that social anxiety is more likely found in false positives. These findings have two major implications: (1) stable social skill deficits appear to relate to long-term disability and (2) change in adolescence is predictive of psychosis.

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