Subtypes of Clinical High Risk for Psychosis that Predict Antipsychotic Effectiveness in Long-Term Remission

Abstract

Introduction In a previous report, we used canonical correlation analysis to classify individuals with clinical high risk (CHR) of psychosis into the 3 subtypes: subtype-1, characterized by extensive negative symptoms and cognitive deficits, appeared to have the highest risk for conversion to psychosis; subtype-2, characterized by thought and behavioral disorganization, with moderate cognitive impairment; subtype-3, characterized by the mildest symptoms and cognitive deficits. The present study attempted to identify these subtypes’ response to antipsychotic (AP) treatment. Methods A total of 289 individuals with CHR were identified and followed up for 2 years. Individuals with CHR were classified by subtype. Use of APs was examined at 2-month, 1-year, and 2-year follow-up interviews that inquired after the subjects’ medication history since the first visit. The main outcome was remission, determined according to global assessment of function (GAF) score (i. e., functional outcome) and SIPS positive symptom score (symptomatic outcome) at the follow-up points. Results Among the 289 individuals with CHR included in the current analysis, 223 (77.2%) were treated using APs for at least 2 weeks during the follow-up period. Individuals with CHR tended to show significant improvement in both symptoms and function after 2 years, but subtypes exhibited significantly different trajectories. Subtype status can predict AP treatment outcome in terms of remission. The likelihood of remission differed significantly among the subtype groups. The remission rates for individuals with subtypes 1–3 treated using AP were 13.5%, 36.1%, and 67.0%, respectively. Discussion These subtypes may be of clinical value in AP treatment decision-making in the CHR population.

Serum Levels of Tumor Necrosis Factor-α and Vascular Endothelial Growth Factor in the Subtypes of Clinical High Risk Individuals: A Prospective Cohort Study

“…Each participant signed an informed consent form, and those under the age of 18 had their guardians sign the forms (Figure 1). [14][15][16]…”

“…Previous research has indicated that there may be distinct underlying pathophysiological mechanisms among different subtypes characterized by prodromal symptoms and cognitive impairment of different severities of CHR individuals for psychosis. 16 By stratifying our sample, we aimed to explore potential differences in inflammatory markers and angioneurins that may be associated with each symptom profile. Emerging evidence in the field of immunology and psychiatry indicates that inflammation plays a crucial role in the development and progression of psychotic disorders.…”

Recent Updates on Predicting Conversion in Youth at Clinical High Risk for Psychosis

“…Several publications have used novel analytic methods to identify neurocognitive subtypes as a means of parsing the heterogeneity among CHR [87][88][89][90]. Velthorst et al [87], using hierarchical clustering on NAPLS1 data, found that the subgroup with significant neurocognitive impairment had the greatest risk of psychotic conversion (58%) compared to mildly impaired (24%) or normal/high performance (10.3%) subgroups.…”

The specificity of the auditory P300 responses and its association with clinical outcomes in youth with psychosis risk syndrome

“…In addition to having positive symptoms, PRS individuals often exhibit a certain degree of negative symptoms (such as social isolation and lack of will), disintegrating symptoms (such as strange behavior and difficulty concentrating), and general symptoms (such as sleep disorders and emotional abnormalities), which usually appear before or accompanied by positive symptoms ( McGlashan et al., 2006 ). These non-positive symptoms can reflect the severity of psychological abnormalities in PRS individuals ( Gupta, Cowan, Strauss, Walker & Mittal, 2021 ), and also have a certain impact on the clinical outcomes of PRS individuals ( Nelson et al., 2013 ; Zhang et al., 2021 ). The majority of PRS individuals have non-positive symptoms mainly characterized by anxiety and depression emotional symptoms, and the comorbidity of anxiety and depressive disorders with PRS is very common ( Fusar-Poli, Nelson, Valmaggia, Yung & McGuire, 2014 ).…”