Ricardo E. Carrión1, Barbara A. Cornblatt1, Peter Bachman2, Aysenil Belger3, Erica Duncan4, Jason Johannesen5, Margaret Niznikiewicz6, Brian J. Roach7, Jean Addington8, Kristin Cadenhead9, NAPLS Consortium, Daniel H. Mathalon7,10; 1Zucker Hillside Hospital, 2University of Pittsburgh, 3University of North Carolina, 4Emory University, 5Yale University, 6Harvard Medical School, 7San Francisco VA Healthcare System, 8University of Calgary, 9University of California, San Diego, 10University of California, San Francisco
Recent research in patients with schizophrenia has demonstrated complex relationships between early auditory processing deficits, neurocognition, social cognition, negative symptoms, and social functioning. However, the interrelationships and impact of these variables on social (i.e., interpersonal relationships) functioning impairments prior to the onset of the illness is unclear. The present study used a structural equation modeling (SEM) approach to integrate these factors to determine the specific determinants and pathways that lead to poor functioning in a large sample of treatment-seeking individuals at clinical high-risk (CHR) for psychosis. Participants were 765 CHR individuals enrolled and prospectively followed in the North American Prodrome Longitudinal Study (NAPLS2). We evaluated several theoretically based models with pathways starting from mismatch negativity (MMN) deficits to functioning. The intervening variables included neurocognitive performance, social cognition, and negative symptom levels. Social functioning was assessed with the GF:Social scale. Prodromal symptoms were assessed using the Scale of Prodromal Symptoms (SIPS/SOPS). Model estimation was performed using AMOS v16. A final trimmed model revealed that early auditory information processing (MMN) had a direct effect on neurocognition, neurocognition had a direct effect on negative symptoms, and both neurocognition and negative symptoms had direct effects on social functioning. The direct effect from social cognition to functioning was not significant. Our findings reveal a complex relationship between MMN reductions, neurocognition, negative symptoms and social outcomes in individuals at CHR for psychosis. These results may have implications for early intervention strategies that aim to improve functional trajectories in young individuals at high risk of developing psychosis.
