Follow-up of subjects with suspected pre-psychotic state in Taiwan

Objective: To describe the outcomes of subjects with suspected pre-psychotic state in Taiwan.

Methods: A prospective clinical observation was performed on subjects recruited by referrals from a community-based population. Three pre-psychotic risk groups were established by means of clinical interviews: an ultra-high risk group (UHR; 59 subjects), an intermediate-risk group (IRG; 46 subjects), and a marginal-risk group (MRG; 48 subjects). Also recruited were 60 subjects with first-episode psychosis (FEP) and 144 normal controls (NC group). All subjects were aged 16 to 32 years.

Results: Of the 59 UHR subjects, 21 (35.6%) converted to FEP, including 15 with schizophrenia (6 had relatively brief positive yet persistent prominent negative symptoms), 2 with schizophreniform disorder, 1 with schizoaffective disorder, 2 with brief psychotic disorder, and 1 with bipolar disorder. The cumulative±SE rate of conversion to psychosis was 21.7%±5.4% at 6 months, 28.2%±6.2% at 12 months, 30.4%±6.4% at 18 months, and 33.3%±6.8% at 24 months. The UHR subjects who converted had a higher rate of initial antipsychotic use than those who did not convert. Only half of the IRG and two-thirds of the MRG subjects received follow-up, and none of them developed FEP.

Conclusions: Our results lent support to both sides of the current debate regarding establishing a new diagnostic category of "psychosis risk syndrome." The divergent trajectories of the UHR subjects deserve more clinical attention, especially with regard to the use of antipsychotics and the presence of a group with prominent negative symptoms.