High remission rates from an initial ultra-high risk state for psychosis Andor E. Simon a,b, ⁎, Daniel Umbricht c a Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, 4101 Bruderholz, Switzerland b University Hospital of Psychiatry, University of Bern, 3010 Bern, Switzerland c Clinical Research and Exploratory Medicine Neuroscience, Hoffmann-La Roche Ltd., Basel, Switzerland article info abstract Article history: Received 15 May 2009 Received in revised form 27 September 2009 Accepted 4 October 2009 Available online 24 October 2009 Objective: To investigate the proportion of patients among subjects initially identified as fulfilling the ultra-high risk (UHR) criteria for psychosis using the Scale of Prodromal Symptoms (SOPS) who fully remitted after one year. Method: Seventy-two patients between 14 and 40 years who were referred to the Bruderholz Early Psychosis Outpatient Service in Switzerland and who met UHR criteria were included in the present study. At 1-year follow-up, data for 52 patients were available. Patients with transition to psychosis and patients with sustained UHR criteria were defined as ‘cases’, and patients with remission from UHR criteria as ‘non-cases’. We compared clinical and socio- demographic characteristics between these two patient groups at baseline. Results: 13.5% of the patients converted to full-blown psychosis within one year, one quarter displayed sustained UHR criteria, and 59.2% of the patients fully remitted from the initial UHR status. Outcome was independent of medication or treatment status. ‘Cases’ and ‘non-cases’ did not differ significantly on socio-demographic and clinical variables at baseline. Conclusions: The chance of remission to a non-risk state was over fourfold higher than the chance of conversion to psychosis within a year of establishing UHR status. Our data underline that the commonly used symptoms to identify UHR patients are often transitory and may not capture the stable core of developing psychosis. This highlights the danger of provoking anxiety and stigmatization in mislabeled individuals and missing true at-risk patients who present features of the psychosis core, but who do not yet—or maybe never will—manifest positive symptoms. © 2009 Elsevier B.V. All rights reserved. Keywords: Early psychosis Ultra-high risk 1. Introduction International research programs have contributed to the creation of operationally defined criteria to identify indivi- duals at risk for schizophrenia. These criteria are based on a combination of trait and state risk factors for psychosis and primarily focus on attenuated positive psychotic symptoms and have been termed the ‘ultra-high risk’ (UHR) criteria (Yung et al., 1996; Miller et al., 2002). In recent years, the reported transition rates from an UHR state to full-blown psychosis have been decreasing from above 50% (Miller et al., 2002) to as low as 15% (Haroun et al., 2006; Yung et al., 2008). This drop in reported transition rates arguably raises the question if UHR subjects who do not convert to psychosis remain at risk for psychosis or whether they actually recover from such a state. Psychotic-like experiences have been found to occur commonly in the general population (van Os et al., 2001; Rössler et al., 2007). They may particularly occur in adoles- cents and young adults in a variety of mental states, where they may be of transitory character and may not necessarily foreshadow psychosis (Simon et al., 2009). Thus, there is evidence to suggest that in a subgroup UHR symptoms may represent a transitory rather than a stable phenomenon and may occur without reflecting an inherent psychosis risk. Schizophrenia Research 116 (2010) 168–172 ⁎ Corresponding author. Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Psychiatric Outpatient Services, Department of Psychiatry, 4101 Bruderholz, Switzerland. Tel.: +41 61 425 45 45; fax: +41 61 425 45 46. E-mail address: andor.simon@bluewin.ch (A.E. Simon). 0920-9964/$ – see front matter © 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2009.10.001 Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres