Outcome in patients converting to psychosis following a treated clinical high risk state

Abstract

Aim: We explored 2-year outcomes in a sample of clinical high risk (CHR) patients who converted to psychosis despite receiving interventions.

Methods: Of 167 CHR patients, 18 had converted to psychosis and received treatment for their first episode of psychosis in an early intervention service over 2 years.

Results: Compared to patients admitted directly to the same early intervention service without having been identified as CHR prior to onset of psychosis, CHR converters were in remission for fewer months (M = 5 vs M = 10); were more likely to be prescribed more than 1 antipsychotic medication (90% vs 68%) and to receive clozapine treatment (38% vs 2%) over 2 years.

Conclusions: CHR patients who convert to psychosis may be inherently more resistant to comprehensive treatment and may have poorer outcomes. Conversion to psychosis from a state of CHR can be reduced to a rate of 10%-12% following interventions, yet outcomes for patients who convert despite such interventions remain unexplored.

Keywords: clinical high risk for psychosis; clozapine; first-episode psychosis; outcome; remission.