Lack of Diagnostic Pluripotentiality in Patients at Clinical High Risk for Psychosis: Specificity of Comorbidity Persistence and Search for Pluripotential Subgroups

Abstract

More than 20 years after the clinical high risk syndrome for psychosis (CHR) was first articulated, it remains controversial whether the CHR syndrome predicts onset of psychosis with diagnostic specificity or predicts pluripotential diagnostic outcomes. Recently, analyses of observational studies, however, have suggested that the CHR syndrome is not pluripotential for emergent diagnostic outcomes. The present report conducted additional analyses in previously reported samples to determine (1) whether comorbid disorders were more likely to persist in CHR patients compared to a comparison group of patients who responded to CHR recruitment efforts but did not meet criteria, termed help-seeking comparison subjects (HSC); and (2) whether clinically defined pluripotential CHR subgroups could be identified. All data were derived from 2 multisite studies in which DSM-IV structured diagnostic interviews were conducted at baseline and at 6-month intervals. Across samples we observed persistence of any nonpsychotic disorder in 80/147 CHR cases (54.4%) and in 48/84 HSC cases (57.1%, n.s.). Findings with persistence of anxiety, depressive, and bipolar disorders considered separately were similar. Efforts to discover pluripotential CHR subgroups were unsuccessful. These findings add additional support to the view that the CHR syndrome is not pluripotential for predicting various diagnostic outcomes but rather is specific for predicting emergent psychosis.

Can We Predict Psychosis Outside the Clinical High-Risk State? A Systematic Review of Non-Psychotic Risk Syndromes for Mental Disorders

“… 2 , 15 , 16 A recent long-term follow-up study directly demonstrated that CHR-P is not a pluripotent group for predicting the onset of new mental disorders but is specific for psychotic disorders. 15 , 46 It also suggested that the nonpsychotic comorbidity of CHR-P is not the result of CHR-P but that it existed from the baseline. 16 Meta-analytic results have confirmed that approximately 40% of psychosis risk patients already have comorbid depressive disorders at baseline.…”

Progression from being at-risk to psychosis: next steps

“…In fact, when improved functioning was added to symptom remission, less than 40% of those who did not make the transition to psychosis met criteria for being “in remission” 97 . Recent papers from NAPLS 98 further differentiated those who did not convert to psychosis into three groups based on symptom ratings at 24 months: (1) those in remission defined as having subthreshold ratings on attenuated psychotic symptoms, (2) symptomatic individuals defined as those who continue to have non-worsening attenuated psychotic symptoms and (3) progression where attenuated psychotic symptoms either worsened or new symptoms emerged. Individuals from the three trajectory groups differed in functioning, cognition and a range of symptoms at 24 months.…”

Ultra-high-risk paradigm: lessons learnt and new directions

“…We will study whether that leads to a higher proportion of subsequent FEPs being identified prior to transition and even whether transition rates are affected by such access and care. While the UHR criteria do indeed have a higher valence for psychotic disorders,25 they also have, to a lesser extent, some valence for non-psychotic syndromes. Most UHR cases do not progress to FEP and may either manifest at baseline or progress to (comorbid) non-psychotic disorders (eg, mood, anxiety and/or substance use disorders) 26…”