title: Symptomatic and functional remission of subjects at clinical high risk for psychosis: a 2-year naturalistic observational study.
abstract: BACKGROUND
  The aim of this study was to assess the frequency and predictors of symptomatic and functional remission in individuals at clinical high risk (CHR) for psychosis at 1-2 years of follow-up.
  
  
  METHODS
  Help-seeking CHR individuals with symptomatic (Scale of Prodromal Symptoms (SOPS) positive scores <3) and functional (Global Assessment of Functioning (GAF) score >60) (CHR-R) remission at 12-24 months were compared to non-remitted individuals (CHR-NR) regarding baseline and treatment characteristics, symptom changes and predictors. Time to full remission was compared with that of symptomatic remission only.
  
  
  RESULTS
  Of 73 individuals, 29 (39.7%) achieved full remission; 44 (60.3%) did not. Compared to CHR-NR individuals, CHR-R individuals had lower baseline SOPS positive symptoms (p=0.017), antipsychotic use (p=0.004), antipsychotic chlorpromazine dose equivalents (p=0.001) and anxiolytic use (p=0.004). In survival analyses, the estimated full remission rate was 48.3% (95% confidence interval (CI)=36.2-61.9) and symptomatic remission rate was 67.5% (CI95=55.4-79.2). Time to full remission was longer than time to symptomatic remission (p=0.017). Linear mixed-effect models revealed significantly greater improvements from 6 months onward in CHR-R subjects compared to CHR-NR subjects regarding SOPS positive symptoms (p=0.003), highest SOPS positive symptom (p<0.001) and GAF scores (p=0.004). Examining baseline predictors, time to full remission was significantly longer in patients with higher SOPS positive scores (p=0.017).
  
  
  CONCLUSIONS
  More stringent remission criteria that include functional status in addition to attenuated positive symptom severity should be applied to CHR subjects. Furthermore, more attention should be given to CHR individuals with highly positive prodromal symptoms at baseline.
authors.affiliation: Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea.
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Lee
authors.affiliation: Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Nyun
authors.initials: SN
authors.lastname: Kim
authors.affiliation: The Zucker Hillside Hospital, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA; Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
authors.affiliation: Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Byun
authors.affiliation: Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Euitae
authors.initials: E
authors.lastname: Kim
authors.affiliation: Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Joon Hwan
authors.initials: JH
authors.lastname: Jang
authors.affiliation: Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Do-Hyung
authors.initials: DH
authors.lastname: Kang
authors.affiliation: Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Je-Yeon
authors.initials: JY
authors.lastname: Yun
authors.affiliation: Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea. Electronic address: kwonjs@snu.ac.kr.
authors.forename: Jun Soo
authors.initials: JS
authors.lastname: Kwon
mesh_terms: D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002746:Chlorpromazine / Q000627:therapeutic use; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D062706:Prodromal Symptoms; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy*; D012074:Remission Induction; D012306:Risk; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D002746:Chlorpromazine
keywords: Antipsychotics; Clinical high risk for psychosis; Functioning; Nonconverters; Stringent remission criteria