Prognostic indicators of functional outcome in first episode psychosis: Linguistic, Anatomical, and Metabolic Predictors of Early Social and Vocational Outcome

A significant cause of disease related burden in schizophrenia relates to reductions in social and occupational functioning. Thus, understanding the variables that are associated with good versus poor functional prognosis is key to improving overall patient outcomes. This dissertation assessed the associations between baseline variables and later occupational and social deficits in the first year of treatment. In chapter 1, we used automated linguistic analysis software programs to determine if elements of speech production were aberrant in patients versus healthy controls. These features were then entered into a prototypical constraint-based algorithm to identify any dependencies with vocational inactivity (NEET), or scores on the Social and Occupational Functioning Assessment Scale (SOFAS). Only reduced speech (lower total words spoken) explained worsened occupational and community functioning. In chapter 2 we assessed whether baseline cortical thickness or local gyrification index (LGI) were associated with baseline clinical severity and later social and vocational status. We identified increased gyrification in frontal and parietal regions to be associated with increased symptom burden at baseline, as well as with a higher status of vocational inactivity following treatment. Finally, we assessed whether central anti-oxidant tone measured in-vivo was associated with better social and vocational outcomes, revealing an association between higher glutathione levels at baseline and improved functional outcomes in the first year of treatment. By elucidating these mechanisms within early psychosis samples, clinicians may be able to augment standard treatment paradigms to improve outcomes among patients at risk of poor treatment response.