BACKGROUND: Cognitive deficits are a core component of schizophrenia and among the strongest determinants of functional disability in psychotic illnesses. In particular, impairment in information processing speed has been demonstrated to be among the most significant in patients. Poor processing speed not only frequently occurs prior to psychosis onset during the prodromal or clinical high risk phase of psychotic illness, it has also been found to be a strong predictor of conversion to psychosis. However, the neurobiological basis of impaired processing speed in the clinical high risk population is not well understood. Functional connectivity during resting state fMRI provides useful insights into the organization and communication between brain regions that may elucidate the brain circuit basis underlying processing speed. OBJECTIVE: To identify the strongest link between brain functional connectivity and a measure of information processing speed in individuals at clinical high risk for conversion to psychosis by utilizing a data-driven analysis. METHODS: Cognitive and resting state fMRI data were collected from 198 clinical high risk participants and 123 neurotypical controls in the second phase of the North American Prodromal Longitudinal Study. Processing speed was measured by the Brief Assessment of Cognition in Schizophrenia Symbol Coding task. A multivariate pattern analysis was used to identify, at the individual voxel level, how functional connectivity correlates with information processing speed. RESULTS: Clinical high risk participants demonstrated significantly reduced processing speed, relative to neurotypical controls. Similarly, at risk patients who later converted to psychosis (n=17) also showed poorer performance on the BACS Symbol Coding task compared to non-converters. The strongest whole-brain link between connectivity and processing speed within the clinical high risk population was the bilateral amygdala. Specifically, connectivity between the bilateral amygdala and a functional brain network known as the salience network correlated with processing speed. CONCLUSIONS: Functional connectivity between the bilateral amygdala and the salience network was linked to individual variation in processing speed in the clinical high risk population. This affirmed a growing literature that implicates amygdala involvement in cognitive function and provides a potential biomarker for psychosis risk prior to diagnosis.

Programs providing interventions for early psychosis are becoming commonplace in the United States (US); however the terrain of existing services within programs remains undocumented. Unlike other countries, the US does not have a systematic approach to defining and treating this population. We examined program characteristics, clinical services, and treatment population parameters for early intervention programs across the US. A semi-structured telephone interview was conducted with program directors between July 2013 and April 2014. Content analysis was used to identify the presence or absence of 32 evidenced based practices recently recommended for early intervention programs (Addington, et al., 2013). Frequent client requests were identified and functional definitions of the population served were assessed. A total of 34 eligible programs were identified; 31 (91.2%) program representatives agreed to be interviewed. Of the 32 essential components, the most prevalent were individual psychoeducation and outcomes tracking; the least prevalent were outreach services and communication with inpatient units. The population was most frequently defined by age restrictions, and restrictions on the duration of psychosis. Emergent themes of client requests included functional and social recovery as well as help meeting practical needs. Findings have the ability to assist researchers and policy-makers in determining best practice models and creating measures of fidelity. This study provides critical feedback on services for the early psychosis population and identifies research to practice gaps and areas for improvement moving forward.