Outcomes of nontransitioned cases in a sample at ultra-high risk for psychosis.
OBJECTIVE
Two-thirds of individuals identified as at ultra-high risk for psychosis do not develop psychotic disorder over the medium term. The authors examined outcomes in a group of such patients.


METHODS
Participants were help-seeking individuals identified as being at ultra-high risk for psychosis 2-14 years previously. The 226 participants (125 female, 101 male) completed a follow-up assessment and had not developed psychosis. Their mean age at follow-up was 25.5 years (SD=4.8).


RESULTS
At follow-up, 28% of the participants reported attenuated psychotic symptoms. Over the follow-up period, 68% experienced nonpsychotic disorders: mood disorder in 49%, anxiety disorder in 35%, and substance use disorder in 29%. For the majority (90%), nonpsychotic disorder was present at baseline, and it persisted for 52% of them. During follow-up, 26% of the cohort had remission of a disorder, but 38% developed a new disorder. Only 7% did not experience any disorder at baseline or during follow up. The incidence of nonpsychotic disorder was associated with more negative symptoms at baseline. Female participants experienced higher rates of persistent or recurrent disorder. Meeting criteria for brief limited intermittent psychotic symptoms at intake was associated with lower risk for persistent or recurrent disorder.


CONCLUSIONS
Individuals at ultra-high risk for psychosis who do not transition to psychosis are at significant risk for continued attenuated psychotic symptoms, persistent or recurrent disorders, and incident disorders. Findings have implications for ongoing clinical care.
From the Telethon Kids Institute, University of Western Australia, Subiaco; the School of Psychology, University of Birmingham, Edgbaston, Birmingham, U.K.; the Melbourne Neuropsychiatry Centre, Melbourne, Australia; the Institute of Brain, Behaviour, and Mental Health, University of Manchester, Manchester, U.K.; and Orygen Youth Health Research Centre, Melbourne, Australia.
Ashleigh
A
Lin
Stephen J
SJ
Wood
Barnaby
B
Nelson
Amanda
A
Beavan
Patrick
P
McGorry
Alison R
AR
Yung
D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D001315:Australia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D010346:Patient Care Management; D063868:Patient Outcome Assessment; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D012008:Recurrence; D018570:Risk Assessment; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology