Recovery from an at-risk state

Clinical and functional outcomes of putatively prodromal youth who do not develop psychosis

Danielle A. Schlosser, Sarah Jacobson, Qiaolin Chen, Catherine A. Sugar, Tara A Niendam, Gang Li, Carrie E. Bearden, Tyrone D. Cannon

Research output: Contribution to journalArticle

84 Citations (Scopus)

Abstract

Background: The "clinical high risk" (CHR) construct was developed to identify individuals at imminent risk of developing psychosis. However, most individuals identified as CHR do not convert to psychosis, and it is unknown whether these nonconverting individuals actually recover from an at-risk state.Methods: Eighty-four prospectively identified patients meeting CHR criteria, and 58 healthy comparison subjects were followed in a 2-year longitudinal study. Analyses examined rates of conversion, clinical, and functional recovery. Proportional cause-specific hazard models were used to examine the effects of baseline and time-varying predictors on conversion and remission. Trajectories of symptoms and psychosocial functioning measures were compared across outcome groups.Results: Competing risk survival analyses estimated that 30% of CHR subjects convert to psychosis by 2 years, while 36% symptomatically remit and 30% functionally recover by 2 years. Lower levels of negative and mood/anxiety symptoms were related to increased likelihood of both symptomatic and functional recovery. CHR subjects who remitted symptomatically were more similar to healthy controls in terms of both their baseline and longitudinal symptoms and functioning than the other outcome groups.Conclusions: Nonconverting CHR cases represented a heterogeneous group. Given that nonconverted subjects who remitted symptomatically also presented initially with less severe prodromal symptomatology and showed a distinct normative trajectory of both symptoms and psychosocial functioning over time, it may be possible to refine the CHR criteria to reduce the number of "false positive" cases by eliminating those who present with less severe attenuated positive symptoms or show early improvements in terms of symptoms or functioning.

Original languageEnglish (US)
Pages (from-to)1225-1233
Number of pages9
JournalSchizophrenia Bulletin
Volume38
Issue number6
DOIs
StatePublished - Nov 2012

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Psychotic Disorders
Survival Analysis
Proportional Hazards Models
Longitudinal Studies
Healthy Volunteers
Anxiety

Keywords

  • at-risk
  • conversion
  • functioning
  • prodrome
  • psychosis
  • schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Recovery from an at-risk state : Clinical and functional outcomes of putatively prodromal youth who do not develop psychosis. / Schlosser, Danielle A.; Jacobson, Sarah; Chen, Qiaolin; Sugar, Catherine A.; Niendam, Tara A; Li, Gang; Bearden, Carrie E.; Cannon, Tyrone D.

In: Schizophrenia Bulletin, Vol. 38, No. 6, 11.2012, p. 1225-1233.

Research output: Contribution to journalArticle

Schlosser, Danielle A. ; Jacobson, Sarah ; Chen, Qiaolin ; Sugar, Catherine A. ; Niendam, Tara A ; Li, Gang ; Bearden, Carrie E. ; Cannon, Tyrone D. / Recovery from an at-risk state : Clinical and functional outcomes of putatively prodromal youth who do not develop psychosis. In: Schizophrenia Bulletin. 2012 ; Vol. 38, No. 6. pp. 1225-1233.
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