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. 2024 Nov 8;50(6):1279-1286.
doi: 10.1093/schbul/sbae005.

Non-psychotic Outcomes in Young People at Ultra-High Risk of Developing a Psychotic Disorder: A Long-Term Follow-up Study

Anneliese E Spiteri-Staines  1   2   3 , Alison R Yung  1   4   5 , Ashleigh Lin  6 , Jessica A Hartmann  1   4 , Paul Amminger  1   4 , Patrick D McGorry  1   4 , Andrew Thompson  1   4   7 , Stephen J Wood  1   4   8 , Barnaby Nelson  1   4
Affiliations

Non-psychotic Outcomes in Young People at Ultra-High Risk of Developing a Psychotic Disorder: A Long-Term Follow-up Study

Anneliese E Spiteri-Staines et al. Schizophr Bull. .

Abstract

Background: The majority of individuals at ultra-high risk (UHR) for psychosis do not transition to a full threshold psychotic disorder. It is therefore important to understand their longer-term clinical and functional outcomes, particularly given the high prevalence of comorbid mental disorders in this population at baseline.

Aims: This study investigated the prevalence of non-psychotic disorders in the UHR population at entry and long-term follow-up and their association with functional outcomes. Persistence of UHR status was also investigated.

Study design: The sample comprised 102 UHR young people from the Personal Assessment and Crisis Evaluation (PACE) Clinic who had not transitioned to psychosis by long-term follow-up (mean = 8.8 years, range = 6.8-12.1 years since baseline).

Results: Eighty-eight percent of participants at baseline were diagnosed with at least one mental disorder, the majority of which were mood disorders (78%), anxiety disorders (35%), and substance use disorders (SUDs) (18%). This pattern of disorder prevalence continued at follow-up, though prevalence was reduced, with 52% not meeting criteria for current non-psychotic mental disorder. However, 35% of participants developed a new non-psychotic mental disorder by follow-up. Presence of a continuous non-psychotic mental disorder was associated with poorer functional outcomes at follow-up. 28% of participants still met UHR criteria at follow-up.

Conclusions: The study adds to the evidence base that a substantial proportion of UHR individuals who do not transition to psychosis experience persistent attenuated psychotic symptoms and persistent and incident non-psychotic disorders over the long term. Long-term treatment and re-entry into services is indicated.

Keywords: UHR; comorbid mental disorders; long-term outcomes; ultra-high risk for psychosis.

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Figures

Fig. 1.
Fig. 1.
Recruitment timeline for follow-up assessment.
Fig. 2.
Fig. 2.
Composition of the sample of youth at ultra-high risk for psychosis.
Fig. 3.
Fig. 3.
Prevalence of mental disorders at baseline and follow-up—major groups.
Fig. 4.
Fig. 4.
Trajectory of disorder—overall and by type of disorder. *Trajectory percentages for overall do not sum to 100% as some participants had more than one type of mental disorder.
Fig. 5.
Fig. 5.
Trajectory of SUD by gender.
See this image and copyright information in PMC

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