title: Recovery from an at-risk state: clinical and functional outcomes of putatively prodromal youth who do not develop psychosis.
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.
authors.affiliation: Department of Psychiatry, University of California, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, USA. danielle.schlosser@ucsf.edu
authors.forename: Danielle A
authors.initials: DA
authors.lastname: Schlosser
authors.forename: Sarah
authors.initials: S
authors.lastname: Jacobson
authors.forename: Qiaolin
authors.initials: Q
authors.lastname: Chen
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Sugar
authors.forename: Tara A
authors.initials: TA
authors.lastname: Niendam
authors.forename: Gang
authors.initials: G
authors.lastname: Li
authors.forename: Carrie E
authors.initials: CE
authors.lastname: Bearden
authors.forename: Tyrone D
authors.initials: TD
authors.lastname: Cannon
mesh_terms: D000293:Adolescent; D000342:Affective Symptoms / Q000453:epidemiology; D001007:Anxiety / Q000453:epidemiology; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D062706:Prodromal Symptoms; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000453:epidemiology*; D012075:Remission, Spontaneous; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult