More than a third of individuals at “ultra-high risk” (UHR) of psychosis who did not convert to psychosis over a 6- to 12- year period did develop a new, non-psychotic mental disorder, according to a report in Schizophrenia Bulletin. Further, more than a quarter of these individuals still met criteria for UHR. Ultra-high risk refers to youth or young adults who experience a range of brief intermittent psychotic symptoms and/or subthreshold psychotic experiences, putting them at greatly increased odds of developing a full-threshold psychotic disorder.
“Because this UHR sample never developed a full threshold psychosis, they would not have been targeted for prolonged intervention,” wrote lead author Anneliese E. Spiteri-Staines, Ph.D., of the University of Melbourne, Australia, and colleagues. “However, given their long-term impairment, this group would benefit from longer-term treatment both for their non-psychotic disorders and continuing [attenuated psychosis symptoms].”
The researchers evaluated 102 young people (62% female) enrolled in the Personal Assessment and Evaluation Clinic, a specialized clinic for high-risk youth at the Orygen Mental Health Center in Melbourne. All participants were between 15 and 30 years of age at baseline and met the criteria for UHR but had not converted to full-threshold psychosis at a follow-up assessment 6 to 12 years after their baseline assessment.
UHR status was determined using the Comprehensive Assessment of At-Risk Mental States (CAARMS). Mental disorder diagnosis was assessed using the Structured Clinical Interview for DSM-IV. Transition to psychosis was determined using both the CAARMS and DSM-IV.
Overall, 35% of participants were diagnosed with a new non-psychotic disorder during the follow-up period, while 44% participants had a non-psychotic disorder at baseline that remitted. A further 54% had a non-psychotic disorder that persisted from baseline to follow-up. Altogether, only 6% of participants had not received a diagnosis of any non-psychotic DSM-IV disorder at either baseline or the follow-up assessment. The disorder that was the most persistent over time was mood disorder.
Spiteri-Staines and colleagues also found that of the 84 patients for whom data was available on UHR status at follow-up, 29% continued to meet UHR criteria, and these individuals were more likely to have a co-occurring mental disorder.
“There is a need to better understand the risk factors for the persistence and incidence of non-psychotic disorders in the UHR population, in addition to those associated with risk for developing psychotic disorder,” the researchers wrote. “Sustained clinical attention to monitor and avert these outcomes is warranted.”
For related information, see the Psychiatric News article, “Predicting Psychosis: Field Moves From Assessment of Clinical Risk to Search for Biomarkers.”
(Image: Getty Images/iStock/Vladimir Vladimirov)
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