Assessing symptoms as well as global functioning among young people at clinical high risk of psychosis and following them for at least six months may provide the most accurate view of their clinical outlook, suggested a study issued by JAMA Network Open yesterday.
Most individuals at clinical high risk for psychosis do not transition to psychosis, noted Johanna Seitz-Holland, M.D., Ph.D., of Harvard Medical School, and colleagues. “Early identification of individuals likely to remit could optimize treatment allocation, including clinical trial participation, and understanding remission-related factors may inform preventive strategies and interventions.”
Seitz-Holland and colleagues analyzed data from 614 individuals ages 12 to 30 at clinical high risk of psychosis who participated in the North American Prodromal Longitudinal Study between February 2015 and November 2018, had positive symptoms at baseline, and completed at least one follow-up assessment. The researchers assessed remission at seven follow-up visits over two years using two different methods: measuring positive symptoms only and measuring positive symptoms and global functioning. Individuals who reached remission and continued to meet remission criteria at all subsequent visits were classified as stable.
Participants were more likely to be classified as in remission at any one visit when receiving a symptoms-only assessment compared with a symptoms-and-function assessment (34% versus 21%, respectively). Similarly, remitters were more likely to be classified as stable under the symptoms-only definition compared with symptoms-and-function (54% versus 47%, respectively).
The researchers noted that the chance of staying in remission rose significantly once a person had more than one previous visit recorded in remission. They also found that higher functioning and fewer positive symptoms at baseline were associated with remission; however, other variables such as age, sex at birth, race, use of antipsychotics, use of antidepressants, cognitive performance, and trauma history were not.
“Regardless of the definition used, only one-half of remitters were stable, indicating that remission is a dynamic state and that vulnerability can persist even after functional remission,” the researchers noted. “Our findings tentatively support a stable remission definition based on at least 6 months of sustained remission…. Hence, continued follow-up and facilitated reengagement with clinical services after remission are essential.”
For related information, see the Psychiatric News articles "Predicting Psychosis: Field Moves From Assessment of Clinical Risk to Search for Biomarkers" and "Youth at High Risk for Psychosis: What Happens to Those Who Don’t Become Psychotic?"
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