Outcomes of individuals at risk of psychosis who do not develop psychosis
Outcomes of non-transitioned cases in a sample at ultra-high risk for psychosis.
American Journal of Psychiatry
Lin A, Wood SJ, Nelson B, Beavan A, McGorry P, Yung AR.
Development and persistence of depression, anxiety and substance use disorders and continuation of low-grade psychotic symptoms.
Criteria have been developed that identify individuals at high risk of developing a psychotic disorder such as schizophrenia – the Ultra High Risk (UHR) criteria.
At the heart of the UHR criteria are the presence of subthreshold psychotic symptoms and age in adolescence or young adulthood. About 15 - 30% of UHR individuals develop a psychosis within 12 months, and over 36% after 3 years.
This was the first study to investigate the outcomes of UHR individuals who did not develop psychosis. 311 UHR individuals were followed up for a mean of 7.4 years. 85 (27.3%) developed psychosis, a rate several hundred-fold above that expected in the general population.
In the 226 who did not develop psychosis, the majority either developed incident depressive, anxiety and substance use disorders or had persistent and recurrent non-psychotic disorders, a rate about three- to five-fold above that of the general population.
The study therefore found that subthreshold psychotic symptoms are 'transdiagnostic' – that is, they increase risk for 'non-psychotic' outcomes as well as psychotic disorders. However, they are relatively specific for psychotic disorders. Nonetheless, the UHR criteria may be useful to detect young people not only at risk for psychosis but other poor outcomes as well.
- Subthreshold psychotic symptoms are risk factors for non-psychotic disorders as well as psychotic disorders.
- It may be that boundaries between mental disorders are not distinct early in the course of illness compared to established disorders.
- Services for UHR individuals need to assess and manage non-psychotic symptoms.
- Treatments need to be developed for these multiple poor outcomes.
Supported by: National Health and Medical Research Council (NHMRC) program grants (350241 and 566529) to Drs Yung, Wood, and McGorry; the Colonial Foundation, and by an unrestricted research grant from Janssen-Cilag. Dr Wood was supported by NHMRC Career Development Awards. Dr Nelson was supported by a Ronald Phillip Griffith Fellowship and an NHMRC Career Development Fellowship. Dr Yung was the recipient of a NHMRC Senior Research Fellowship. Dr Lin was supported by an NHMRC Early Career Fellowship.