Follow-up of subjects labelled with putative pre-psychotic states: Viewed from a transdiagnostic clinical high-at-risk mental state (CHARMS) paradigm

Chen-Chung Liu; Chih-Min Liu; Yi-Ling Chien; Yi-Ting Lin; Ming H Hsieh; Tzung-Jeng Hwang; Hai-Gwo Hwu

doi:10.1016/j.jfma.2021.10.009

Follow-up of subjects labelled with putative pre-psychotic states: Viewed from a transdiagnostic clinical high-at-risk mental state (CHARMS) paradigm

J Formos Med Assoc. 2022 Jun;121(6):1159-1166. doi: 10.1016/j.jfma.2021.10.009. Epub 2021 Oct 31.

Authors

Chen-Chung Liu¹, Chih-Min Liu², Yi-Ling Chien², Yi-Ting Lin², Ming H Hsieh², Tzung-Jeng Hwang², Hai-Gwo Hwu²

Affiliations

¹ Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan. Electronic address: chchliu@ntu.edu.tw.
² Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.

PMID: 34732303
DOI: 10.1016/j.jfma.2021.10.009

Abstract

Background: Follow-up of subjects with putative pre-psychotic states is essential to clarify the transition process to psychosis, while "non-converters" also deserve clinical attention as many may evolve into other psychiatric disorders with diverse outcomes. This study aimed to examine help-seeking individuals who have been labelled at clinical high-risk state but not converting to full-blown psychosis during first two years of follow-up.

Methods: A retrospective observational cohort study of help-seeking subjects was conducted by reviewing medical records of participants in a previous early psychosis study at the study hospital between 2006 and 2020. We portrayed those who developed first episode psychosis after first 2-year follow-up in detail, and provided sketches of clinical macrophenotypes other than psychosis emerging from subjects among different risk groups.

Results: Among 132 eligible subjects, data of 98 (74.2%) were available for detailed evaluation. Of these, 15 transitioned to first-episode psychosis (11.4%) with time to psychosis from 2 to 11 years, 11 had anxiety spectrum (8.3%), 11 had depressive spectrum (8.3%), 10 had obsessive compulsive (7.6%), 5 had bipolar spectrum disorders (3.8%), 13 had predominantly schizotypal (9.8%) and 4 had other personality traits (3%), and 13 had problems attributable to adjustment or developmental issues (9.8%).

Conclusion: Various diagnoses, either full- or sub-threshold, appropriately describe the diverse clinical phenomenology of a cohort presenting with non-specific and/or subthreshold psychotic symptoms. The clinical high-at-risk mental state (CHARMS) paradigm provides a reasonable transdiagnostic approach for orienting clinicians' attention toward young subjects seeking mental health help at an early stage of illness to potentially pluripotent trajectories.

Keywords: At-risk mental state; Follow-up; Pluripotent trajectories; Psychosis; Transdiagnostic paradigm; Transition.

Publication types

Observational Study

MeSH terms

Anxiety Disorders
Bipolar Disorder* / diagnosis
Follow-Up Studies
Humans
Psychotic Disorders* / diagnosis
Psychotic Disorders* / psychology
Retrospective Studies