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Course of clinical high-risk states for psychosis beyond conversion



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.

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Author information

Correspondence to Chantal Michel.

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Financial support

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.

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C. Michel and S. Ruhrmann shared first authorship.

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Michel, C., Ruhrmann, S., Schimmelmann, B.G. et al. Course of clinical high-risk states for psychosis beyond conversion. Eur Arch Psychiatry Clin Neurosci 268, 39–48 (2018).

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  • Clinical high risk
  • Non-conversion
  • Persistence
  • Remission
  • Axis-I diagnosis