Beyond the Descriptive: A Comprehensive, Multidomain Validation of Symptom Trajectories for Individuals at Clinical High Risk for Psychosis.

Abstract

Background: Although the clinical high risk for psychosis (CHR-P) criteria are widely used to ascertain individuals at heightened risk for imminent onset of psychosis, it remains controversial whether CHR-P status defines a diagnostic construct in its own right. In a previous study, CHR-P nonconverters were observed to follow 3 distinct trajectories in symptoms and functioning: remission, partial remission, and maintenance of symptoms and functional impairments at subthreshold levels of intensity.

Methods: Here, we utilized the NAPLS3 (North American Prodrome Longitudinal Study phase 3) sample (N = 806) to determine whether 1) the same trajectory groups can be detected when assessing symptoms at 2-month intervals over an 8-month period and 2) the resulting trajectory groups differ from each other and from healthy control participants and converting CHR-P cases in terms of risk factors, comorbidities, and functional outcomes.

Results: Three distinctive subgroups within the CHR nonconverters were identified, largely paralleling those observed previously. Importantly, these extracted groups, together with non-CHR control participants and CHR converters, differed from each other significantly on putative etiological risk factors (e.g., predicted risk scores, physiological and self-report measures of stress), affective comorbidities, and functional outcomes, thus providing converging evidence supporting the validity of the identified trajectory groups.

Conclusions: This pattern, together with the fact that even the subgroup of CHR-P nonconverters who showed a remission trajectory deviated from healthy control participants, supports treating the CHR-P syndrome not only as a status that denotes risk for onset of full psychosis but also as a marker of ongoing distress for a population that is in need of interventions.