In a cohort study, researchers evaluated the incidence, prevalence, and stability of remission among participants who were at clinical high risk for psychosis. Among the 692 participants (mean age = 18.7 years; 46% female), 614 completed at least one follow-up. Based on the symptoms-only definition, 7% achieved remission at 2 months, 34% experienced remission at least once, and 26% were in remission at their final visit. When the researchers applied the symptoms-and-function criteria, 4% met remission at 2 months, 21% met remission at any point during the study, and 15% met remission at their last visit.
Remission stability was examined in those who had at least one follow-up after achieving remission. Using the symptoms-only criteria, 54% (83 of 153) remained in stable remission, "indicating that the CHR status is a fluctuating condition," lead author Johanna Seitz-Holland, MD, PhD, of the Department of Psychiatry at Mass General Brigham, Harvard Medical School in Boston, Massachusetts, wrote with colleagues. Under the symptoms-and-function definition, 47% (43 of 91) were stable remitters. The likelihood of remaining in remission increased markedly with repeated prior remission visits, reaching 92% for participants with 3 or more such visits.
Mixed-effects logistic regression analyses showed that higher functioning at baseline, as measured by Global Assessment of Functioning scores, was associated with greater likelihood of remission (odds ratio = 1.08), while higher general symptom scores were linked to lower likelihood of remission (odds ratio = 0.80). No significant associations were found for age, sex, race, trauma history, antidepressant or antipsychotic use, or cognitive variables, but descriptive analyses found lower remission prevalence for female patients, patients with a history of trauma, and Black and African American patients. The authors cautioned that results associated with medication should be interpreted with caution because antipsychotics and antidepressants are prescribed most often for severe symptoms and nonadherence impacts their effects.
The investigators used data from 692 participants aged 12 to 30 years who were enrolled in the North American Prodromal Longitudinal Study 3, and conducted follow-up across 7 visits during a 24-month period at 9 sites in the US. The symptoms-only definition of remission was based on the Scale of Prodromal Symptoms and the symptoms-and-function required both symptom reduction—positive symptom ratings of less than 3—and a Global Assessment of Functioning score above 60.
The main limitation of the study, they noted, was missing data for patients at follow-up. Validation is needed beyond NAPLS-3 data set to include other geographical locations, CHR definitions and criteria, and time of ascertainment. Finally, the authors suggested that other dimensional approaches, finer-grain instruments to assess functioning, more detailed studies of functional remission, and variables such as comorbidities and psychosocial factors and treatments should be considered in future research.
The authors concluded that clinical high-risk status is inherently dynamic and that remission, while attainable, often lacks long-term stability. They added that multiple follow-up assessments—particularly beyond two visits—are essential for determining sustained remission and emphasized the importance of continued clinical monitoring following initial recovery.
Full disclosures can be found in the published study.
Source: JAMA Network Open