Clinical and functional characteristics of youth at clinical high-risk for psychosis who do not transition to psychosis

Author for correspondence: Jean Addington, E-mail: [e-mail]

Introduction

Over the past two decades, there has been an international attempt to better understand and identify the early stages of psychosis (McGorry, 2015). Reliable criteria have been developed (McGlashan et al., 2010) which has enabled researchers to prospectively follow individuals considered to be at clinical high risk (CHR) of psychosis, with the goal of being able to distinguish differences between those who go on to develop psychosis and those who do not. However, despite advances in this research, nearly two-thirds of these individuals who meet CHR criteria will not go on to develop a psychotic illness (Fusar-Poli et al., 2012a). This has led to an increase in interest regarding the outcome of CHR individuals who do not make the transition to psychosis. A recent meta-analysis has shown that over a 2-year follow-up approximately 73% of recruited CHR individuals did not convert to psychosis, and that of these individuals, about 43% fully remitted from their attenuated psychotic symptoms (APS) (Simon et al., 2013). Since this meta-analysis, a few other studies have attempted to better understand the outcome of those who do not make the transition to psychosis. Armando et al. (2015) reported that in their small sample of children aged 9–17, they found that only the non-converters who remitted from CHR status improved on functioning. Additionally, although there were no variables that predicted remission, the absence of unusual thought content and lower score on disorganized symptoms were related to better outcome (Armando et al., 2015). Typically, remission has referred to remission of APS severity. However, a recent publication from Korea found that when only APS was considered the remission rate was 56% but when improvement in functioning was added only 39.7% were in remission (Lee et al., 2014).

There has been some interest in better understanding the presence of poor functioning and comorbid psychopathology amongst those who do not go on to convert to psychosis. In an earlier paper with our first cohort in the North American Prodrome Longitudinal Study, we reported that there was significant poor functioning even for those who had remission of APS (Addington et al., 2011). In the OASIS study, in the UK, 71.6% had not...