Specificity of Incident Diagnostic Outcomes in Patients at Clinical High Risk for Psychosis

Abstract

It is not well established whether the incident outcomes of the clinical high-risk (CHR) syndrome for psychosis are diagnostically specific for psychosis or whether CHR patients also are at elevated risk for a variety of nonpsychotic disorders. We collected 2 samples (NAPLS-1, PREDICT) that contained CHR patients and a control group who responded to CHR recruitment efforts but did not meet CHR criteria on interview (help-seeking comparison patients [HSC]). Incident diagnostic outcomes were defined as the occurrence of a SIPS-defined psychosis or a structured interview diagnosis from 1 of 3 nonpsychotic Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) groups (anxiety, bipolar, or nonbipolar mood disorder), when no diagnosis in that group was present at baseline. Logistic regression revealed that the CHR vs HSC effect did not vary significantly across study for any emergent diagnostic outcome; data from the 2 studies were therefore combined. CHR (n = 271) vs HSC (n = 171) emergent outcomes were: psychosis 19.6% vs 1.8%, bipolar disorders 1.1% vs 1.2%, nonbipolar mood disorders 4.4% vs 5.3%, and anxiety disorders 5.2% vs 5.3%. The main effect of CHR vs HSC was statistically significant (OR = 13.8, 95% CI 4.2-45.0, df = 1, P < .001) for emergent psychosis but not for any emergent nonpsychotic disorder. Sensitivity analyses confirmed these findings. Within the CHR group emergent psychosis was significantly more likely than each nonpsychotic DSM-IV emergent disorder, and within the HSC group emergent psychosis was significantly less likely than most emergent nonpsychotic disorders. The CHR syndrome is specific as a marker for research on predictors and mechanisms of developing psychosis.

Diagnostic and Prognostic Significance of Brief Limited Intermittent Psychotic Symptoms (BLIPS) in Individuals at Ultra High Risk

“…33 Recent original studies in UHR individuals ( n = 271) as contrasted to comparison individuals ( n = 171) further confirmed no evidence of diagnostic pluripotentiality with respect to new or incident anxiety, bipolar, or non-bipolar mood disorders. 34 …”

The Clinical High-Risk State for Psychosis (CHR-P), Version II

“…Recent studies have confirmed that CHR-P individuals are not at risk for developing incident bipolar disorders, nonbipolar mood disorders or anxiety disorders 15 compared to control groups and that the vast majority of comorbid disorders observed in CHR-P individuals who do not develop psychosis is already present at the baseline. 16 These findings advance knowledge indicating that the possible outcomes specifically associated with the CHR-P (which may be preferred to the acronym "CHR" to better acknowledge the specificity for psychosis prediction) designation may include the onset of psychotic disorders, remission or persistence of initial symptoms and variable functional outcomes 17 but not an increased risk of emergence of new (incident) nonpsychotic mental disorders.…”

Improving outcomes of first‐episode psychosis: an overview

“…Their risk peaks in the first two years 59 and is specific for the development of psychotic disorders but not for emerging non-psychotic disorders 60,61 . However, less than half of those who will not develop psychosis will eventually remit (35% of the baseline cohort) 62 , since persistent comorbidities (that were already present at baseline [63][64][65] ) and functional impairment are frequently observed at follow-up 64 .…”