Clinical and functional ultra-long-term outcome of patients with a clinical high risk (CHR) for psychosis

Katharina Beck; Erich Studerus; Christina Andreou; Laura Egloff; Letizia Leanza; Andor E Simon; Stefan Borgwardt; Anita Riecher-Rössler

doi:10.1016/j.eurpsy.2019.08.005

Clinical and functional ultra-long-term outcome of patients with a clinical high risk (CHR) for psychosis

Eur Psychiatry. 2019 Oct:62:30-37. doi: 10.1016/j.eurpsy.2019.08.005. Epub 2019 Sep 9.

Authors

Katharina Beck¹, Erich Studerus², Christina Andreou³, Laura Egloff⁴, Letizia Leanza¹, Andor E Simon⁵, Stefan Borgwardt⁶, Anita Riecher-Rössler⁷

Affiliations

¹ University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland; University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland.
² University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland; University of Basel, Department of Psychology, Division of Developmental and Personality Psychology, Basel, Switzerland.
³ University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland.
⁴ University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland; Department of Psychiatry, University of Basel Psychiatric Hospital, Basel, Switzerland.
⁵ University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland; Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, Bruderholz, Switzerland.
⁶ Department of Psychiatry, University of Basel Psychiatric Hospital, Basel, Switzerland.
⁷ University of Basel, Basel, Switzerland. Electronic address: anita.riecher-roessler@unibas.ch.

PMID: 31514058
DOI: 10.1016/j.eurpsy.2019.08.005

Abstract

Background: Few studies have followed up patients with a clinical high risk (CHR) for psychosis for more than 2-3 years. We aimed to investigate the rates and baseline predictors for remission from CHR and transition to psychosis over a follow-up period of up to 16 years. Additionally, we examined the clinical and functional long-term outcome of CHR patients who did not transition.

Methods: We analyzed the long-term course of CHR patients that had been included in the longitudinal studies "Früherkennung von Psychosen" (FePsy) or "Bruderholz" (BHS). Those patients who had not transitioned to psychosis during the initial follow-up periods (2/5 years), were invited for additional follow-ups.

Results: Originally, 255 CHR patients had been included. Of these, 47 had transitioned to psychosis during the initial follow-ups. Thus, 208 were contacted for the long-term follow-up, of which 72 (34.6%) participated. From the original sample of 255, 26%, 31%, 35%, and 38% were estimated to have transitioned after 3, 5, 10, and 16 years, respectively, and 51% had remitted from their high risk status at the latest follow-up. Better psychosocial functioning at baseline was associated with a higher rate of remission. Of the 72 CHR patients re-assessed at long-term follow-up, 60 had not transitioned, but only 28% of those were fully recovered clinically and functionally.

Conclusions: Our study shows the need for follow-ups and clinical attention longer than the usual 2-3 years as there are several CHR patients with later transitions and only a minority of CHR those without transition fully recovers.

Keywords: At-risk mental state; Comorbidity; Functioning; Recovery; Remission; Symptomatology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Disease Progression
Female
Humans
Longitudinal Studies
Male
Middle Aged
Psychotic Disorders / psychology*
Young Adult