Course of clinical high-risk states for psychosis beyond conversion
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The main focus of research on clinical high-risk states for psychosis (CHR) has been the development of algorithms to predict psychosis. Consequently, other outcomes have been neglected, and little is known about the long-term diagnostic and functional outcome among those not converting to psychosis.
In a naturalistic study, incidence, persistence, and remission rates of CHR states according to symptomatic ultra-high risk or cognitive disturbances criteria were investigated in 160 of 246 outpatients of an early detection of psychoses service (21.1% CHR negative and 78.9% CHR positive at baseline) who had not converted to psychosis within follow-up (median 53.7 months, range 13.9–123.7 months).
Remission rate of CHR status was 43.3% of all 194 CHR-positive cases, including converters, or 72.4% if only the 116 non-converters were considered, persistence rate was 27.6%, and new occurrence rate in initially CHR-negative patients was 9.1%. At follow-up, 54.5% of the non-converters met criteria of at least one Axis-I diagnosis, mainly affective and anxiety disorders, and had functional problems. The severity of risk at baseline was not associated with a higher presence of Axis-I diagnosis at follow-up.
During follow-up, CHR symptoms remitted in one-third of initially CHR-positive patients, while almost 10% met CHR criteria newly in CHR-negative adults presenting at early detection services. The presence of CHR criteria seems to maintain the risk for lower functioning and mental disorders, particularly for affective disorders. Thus, therapeutic efforts targeting CHR patients should also focus on the current mental disorders as well as social and role functions to improve the long-term outcome.
KeywordsClinical high risk Non-conversion Persistence Remission Axis-I diagnosis
Compliance with ethical standards
This work was supported by a grant from the Koeln Fortune Program / Faculty of Medicine, University of Cologne [Grant Numbers 8/2005, 27/2006] to Dr. Schultze-Lutter. The study’s sponsor had no role in study design, data collection, or analysis, or in interpretation, writing, or submission of the report.
Conflict of interest
Drs Michel and Schultze-Lutter declare that there are no conflicts of interest in relation to the subject of this study. Professor Ruhrmann received speaker’s honoraria from AstraZeneca, Bristol-Myers Squibb, Essex, and Janssen-Cilag; travel support from Servier; and consultancy honoraria from Roche. Professor Klosterkötter received speaker’s honoraria from AstraZeneca, Bristol-Myers Squibb, and Janssen-Cilag; a research grant from Bristol-Myers Squibb; and is a former member of the expert advisory board of Janssen-Cilag Germany. Professor Schimmelmann has been a consultant and/or advisor to or has received honoraria from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, and Shire.
- 1.Schultze-Lutter F, Michel C, Schmidt SJ, Schimmelmann BG, Maric NP, Salokangas RK, Riecher-Rössler A, van der Gaag M, Nordentoft M, Raballo A, Meneghelli A, Marshall M, Morrison A, Ruhrmann S, Klosterkötter J (2015) EPA guidance on the early detection of clinical high risk states of psychoses. Eur Psychiatry 30(3):405–416CrossRefPubMedGoogle Scholar
- 3.McGlashan TH, Walsh BC, Woods SW (2010) The Psychosis-risk syndrome: handbook for diagnosis and follow-up. Oxford University Press, New YorkGoogle Scholar
- 4.Fusar-Poli P, Borgwardt S, Bechdolf A, Addington J, Riecher-Rössler A, Schultze-Lutter F, Keshavan M, Wood S, Ruhrmann S, Seidman LJ, Valmaggia L, Cannon T, Velthorst E, De Haan L, Cornblatt B, Bonoldi I, Birchwood M, McGlashan T, Carpenter W, McGorry P, Klosterkötter J, McGuire P, Yung A (2013) The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 70(1):107–120CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Miller TJ, McGlashan TH, Rosen JL, Somjee L, Markovich PJ, Stein K, Woods SW (2002) Prospective diagnosis of the initial prodrome for schizophrenia based on the Structured Interview for Prodromal Syndromes: preliminary evidence of interrater reliability and predictive validity. Am J Psychiatry 159(5):863–865CrossRefPubMedGoogle Scholar
- 8.Ruhrmann S, Schultze-Lutter F, Salokangas RK, Heinimaa M, Linszen D, Dingemans P, Birchwood M, Patterson P, Juckel G, Heinz A, Morrison A, Lewis S, von Reventlow HG, Klosterkötter J (2010) Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study. Arch Gen Psychiatry 67(3):241–251CrossRefPubMedGoogle Scholar
- 10.Ruhrmann S, Schultze-Lutter F, Klosterkötter J (2010) Sub-threshold states of psychosis – a challenge to diagnosis and treatment. Clin Neuropsychiatr 7(2):72–87Google Scholar
- 13.Lemos-Giráldez S, Vallina-Fernández O, Fernández-Iglesias P, Vallejo-Seco G, Fonseca-Pedrero E, Paíno-Piñeiro M, Sierra-Baigrie S, García-Pelayo P, Pedrejón-Molino C, Alonso-Bada S, Gutiérrez-Pérez A, Ortega-Ferrández JA (2009) Symptomatic and functional outcome in youth at ultra-high risk for psychosis: a longitudinal study. Schizophr Res 115(2–3):121–129CrossRefPubMedGoogle Scholar
- 20.American Psychiatric Association (APA) (1994) Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV). American Psychiatric. Press, Washington, DCGoogle Scholar
- 22.McGlashan TH, Miller TJ, Woods SW, Rosen JL, Hoffman RE, Davidson L (2001) Structured interview for prodromal syndromes (version 3.0). Yale School of Medicine, PRIME Research Clinic, New HavenGoogle Scholar
- 29.Woods SW, Walsh BC, Addington J, Cadenhead KS, Cannon TD, Cornblatt BA, Heinssen R, Perkins DO, Seidman LJ, Tarbox SI, Tsuang MT, Walker EF, McGlashan TH (2014) Current status specifiers for patients at clinical high risk for psychosis. Schizophr Res 158(1–3):69–75CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Correll CU, Smith CW, Auther AM, McLaughlin D, Shah M, Foley C, Olsen R, Lencz T, Kane JM, Cornblatt BA (2008) Predictors of remission, schizophrenia, and bipolar disorder in adolescents with brief psychotic disorder or psychotic disorder not otherwise specified considered at very high risk for schizophrenia. J Child Adolesc Psychopharmacol 18(5):475–490CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Armando M, Pontillo M, De Crescenzo F, Mazzone L, Monducci E, Lo Cascio N, Santonastaso O, Pucciarini ML, Vicari S, Schimmelmann BG, Schultze-Lutter F (2015) Twelve-month psychosis-predictive value of the ultra-high risk criteria in children and adolescents. Schizophr Res 169(1–3):186–192CrossRefPubMedGoogle Scholar
- 35.Gross G, Huber G, Klosterkötter J, Linz M (1987) Bonner Skala für die Beurteilung von Basissymptomen [BSABS; Bonn Scale for the Assessment of Basic Symptoms]. Springer, BerlinGoogle Scholar
- 36.Schultze-Lutter F, Addington J, Ruhrmann S, Klosterkötter J (2007) Schizophrenia proneness instrument, adult version (SPI-A). Giovanni Fioriti Editore s.l.r., RomeGoogle Scholar
- 39.Wittchen HU, Zaudig M, Fydrich T (1997) SKID - Strukturiertes klinisches Interview für DSM-IV, Achse I und II. Hogrefe, GöttingenGoogle Scholar
- 43.Salokangas RKR, Ruhrmann S, von Reventlow HG, Heinimaa M, Svirskis T, From T, Luutonen S, Juckel G, Linszen D, Dingemans P, Birchwood M, Patterson P, Schultze-Lutter F, Klosterkötter J (2012) Axis I diagnoses and transition to psychosis in clinical high-risk patients EPOS project: prospective follow-up of 245 clinical high-risk outpatients in four countries. Schizophr Res 138(2–3):192–197CrossRefPubMedGoogle Scholar
- 46.Schultze-Lutter F, Michel C, Ruhrmann S, Schimmelmann BG (2014) Prevalence and clinical significance of DSM-5-attenuated psychosis syndrome in adolescents and young adults in the general population: the Bern epidemiological at-risk (BEAR) study. Schizophr Bull 40(6):1499–1508CrossRefPubMedGoogle Scholar
- 47.Nelson B, Yuen HP, Wood SJ, Lin A, Spiliotacopoulos D, Bruxner A, Broussard C, Simmons M, Foley DL, Brewer WJ, Francey SM, Amminger GP, Thompson A, McGorry PD, Yung AR (2013) Long-term follow-up of a group at ultra high risk (“prodromal”) for psychosis: the PACE 400 study. JAMA. Psychiatry 70(8):793–802Google Scholar