title: Adolescents at ultra-high risk for psychosis: long-term outcome of individuals who recover from their at-risk state.
abstract: Studies of individuals at ultra-high risk (UHR) for psychosis have mostly reported on long-term outcome of those individuals who develop psychosis compared to those who do not. However, these studies show that a large number of UHR individuals no longer meet criteria for UHR at follow-up. Therefore, this study aimed to investigate functioning at 6-year follow-up in remitted individuals, and to explore the course of their clinical symptoms. Forty-four UHR adolescents completed extensive clinical assessments at baseline and participated in long-term follow-up approximately six years later. UHR adolescents who had either converted to psychosis or who still met UHR criteria (n=26) at follow-up were compared to individuals who had remitted from their UHR status (n=18) on clinical and psychosocial variables. Results show that more than 40% of UHR individuals had fully remitted from their UHR status. At six-year follow-up, remitted individuals had improved clinically on most symptoms. The course of their symptoms showed that the most substantial reduction in positive symptoms occurred within the first two years, while improvements in general, mood and anxiety symptoms occurred at a later stage. Baseline socio-demographic characteristics and clinical symptoms did not distinguish between remitters and non-remitters. Although remitters no longer met criteria for UHR, they did meet diagnostic criteria for a wide range of psychiatric disorders. Our findings suggest that, when related to long-term outcome, UHR criteria capture non-specific psychotic symptoms rather than risk for psychosis per se and relate more to general psychopathology.
authors.affiliation: Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands. Electronic address: s.dewit-2@umcutrecht.nl.
authors.forename: S
authors.initials: S
authors.lastname: de Wit
authors.affiliation: Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands.
authors.forename: P F
authors.initials: PF
authors.lastname: Schothorst
authors.affiliation: Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Oranje
authors.affiliation: Department of Clinical Child and Adolescent Studies, Leiden University, Leiden, The Netherlands.
authors.forename: T B
authors.initials: TB
authors.lastname: Ziermans
authors.affiliation: Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Durston
authors.affiliation: Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands.
authors.forename: R S
authors.initials: RS
authors.lastname: Kahn
mesh_terms: D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D012306:Risk; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: Clinical diagnosis; Long-term outcome; Psychosis; Remission; Ultra-high risk