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Study shows heterogeneity of psychosis risk in individuals at clinical high risk

Among individuals at clinical high risk for psychosis, those with brief limited intermittent psychotic symptoms had higher risk for psychosis than those with attenuated psychotic symptoms. Researchers suggest clinical high-risk guidelines be updated to reflect these differences.

Paolo Fusar-Poli, MD, PhD, of King’s College, London, and colleagues conducted a meta-analysis of 33 studies (n = 4,227) to compare psychosis risk among subgroups of individuals at clinical high risk for psychosis.

Psychosis risk did not significantly differ among individuals with attenuated psychotic symptoms or genetic risk and deterioration syndrome at any time point.

There was greater evidence of higher risk for psychosis among individuals with brief limited intermittent psychotic symptoms compared with individuals with attenuated psychotic symptoms and those with genetic risk and deterioration syndrome after 24 months of follow-up. However, this was not evident at 6 or 12 months, according to researchers.

Psychosis risk peaked at 24 months and then plateaued among individuals with brief limited intermittent psychotic symptoms and those with attenuated psychotic symptoms.

Researchers found no evidence that individuals with genetic risk and deterioration syndrome had higher psychosis risk than those without clinical high risk for psychosis at any time point.

“Overall, the study by Fusar-Poli et al has several important clinical and research implications,” Barbara A. Cornblatt, PhD, MBA, and Ricardo E. Carrión, PhD, of the North Shore–Long Island Jewish Health System, Glen Oaks, New York, wrote in an accompanying editorial. “One major clinical application is to enable the level of risk to be assessed based on subgroup assignment and to tailor treatment accordingly. From a research perspective, one approach to refining prediction is to deconstruct the heterogeneous [clinical high risk] entity back into its original components and then focus on the most validated subgroup, the [attenuated psychotic symptoms], as was done recently by Cornblatt and colleagues. On the other hand, if the sample is sufficiently large, research studies can compare the three subgroups separately or replace the current mixture with a more stage-based model that divides the at-risk population into subgroups based on where patients fall in progression of illness from less to more severe. In summary, the findings of Fusar-Poli et al challenge the way prodromal identifications have been made for the past 20 years and will undoubtedly have a positive effect on high-risk research and future criterion modifications.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.