Abstract
Recent evidence has suggested that psychosis could develop not only in people at clinical high risk for psychosis (CHR-P) but also in those with clinical risk syndromes for emergent nonpsychotic mental disorders. The proportion of people with these clinical risk syndromes who will develop psychosis rather than to other nonpsychotic mental disorders is undetermined. Electronic databases were searched for studies reporting on clinical risk syndromes for the development of emergent nonpsychotic mental disorders. Incidence of emerging psychotic and nonpsychotic mental disorders defined on the ICD or DSM. Of a total of 9 studies relating to 3006 nonpsychotic at-risk individuals were included. Within prospective studies (n = 4, sample = 1051), the pooled incidence of new psychotic disorders across these clinical risk syndromes was of 12.9 per 1000 person-years (95% CI: 4.3 to 38.6) and that of nonpsychotic disorders (n = 3, sample = 538) was of 43.5 per 1000 person-years (95% CI: 30.9 to 61.3). Psychotic disorders may emerge outside the CHR-P paradigm, from clinical risk syndromes for incident nonpsychotic disorders, albeit at lower rates than in the CHR-P group. The clinical risk syndromes for emerging nonpsychotic disorders may exhibit a pluripotential risk of developing several types of mental disorders compared with CHR-P. If substantiated by future research, the current findings suggest that it may be useful to move beyond the current strategy of identifying individuals meeting CHR-P criteria only.
Highlights
Recent evidence has suggested that psychosis could develop in people at clinical high risk for psychosis (CHR-P) and in those with clinical risk syndromes for emergent nonpsychotic mental disorders
Psychotic disorders may emerge outside the CHR-P paradigm, from clinical risk syndromes for incident nonpsychotic disorders, albeit at lower rates than in the CHR-P group
The clinical risk syndromes for emerging nonpsychotic disorders may exhibit a pluripotential risk of developing several types of mental disorders compared with CHR-P
Summary
A true prodrome refers to the early symptoms and signs that inevitably precede the acute clinical phase of an illness.[1]. The term clinical high risk for Psychosis (CHR-P) state describes a condition with particular clinical features that lead to an elevated risk of developing the illness.[2]. Several possible explanations regarding this phenomenon have been proposed, such as more effective early intervention, leadtime bias and the identification of false positives who were never at-risk of psychosis.[10–12] The latter point is likely due to heterogeneous recruitment strategies and dilution of enrichment before the CHR-P assessment, an issue that has been extensively addressed in recent publications.[12–14]. 2 independent studies confirmed that the CHR-P criteria have proven to be accurate for predicting the onset of psychosis but not of nonpsychotic disorders.[15,16] This finding contradicts earlier assumptions that CHR-P is pluripotential in term of diagnostic outcomes (eg, with an “At-Risk Mental State, ARMS” predicting several incident mental disorders). At the current stage of knowledge, what is not clear is whether individuals with other clinical risk syndromes beyond the CHR-P may be at-risk of developing psychosis
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