Review article Moving beyond transition outcomes: Meta-analysis of remission rates in individuals at high clinical risk for psychosis Andor E. Simon a,b,c , Stefan Borgwardt a , Anita Riecher-Rössler a , Eva Velthorst d , Lieuwe de Haan d , Paolo Fusar-Poli e,n a University Psychiatry Clinics, University of Basel, 4031 Basel, Switzerland b Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, 4101 Bruderholz, Switzerland c University Hospital of Psychiatry, University of Bern, 3010 Bern, Switzerland d Department of Psychiatry, Academic Medical Centre, Meibergdreef 5, Amsterdam, Netherlands e Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park 16, SE 5AF London, UK article info Article history: Received 25 August 2012 Received in revised form 24 February 2013 Accepted 3 March 2013 Keywords: Psychosis Schizophrenia At risk Prodromal ARMS UHR abstract Recent evidence suggests that transition risks from initial clinical high risk (CHR) status to psychosis are decreasing. The role played by remission in this context is mostly unknown. The present study addresses this issue by means of a meta-analysis including eight relevant studies published up to January 2012 that reported remission rates from an initial CHR status. The primary effect size measure was the longitudinal proportion of remissions compared to non-remission in subjects with a baseline CHR state. Random effect models were employed to address the high heterogeneity across studies included. To assess the robustness of the results, we performed sensitivity analyses by sequentially removing each study and rerunning the analysis. Of 773 subjects who met initial CHR criteria, 73% did not convert to psychosis along a 2-year follow. Of these, about 46% fully remitted from the baseline attenuated psychotic symptoms, as evaluated on the psychometric measures usually employed by prodromal services. The corresponding clinical remission was estimated as high as 35% of the baseline CHR sample. The CHR state is associated with a significant proportion of remitting subjects that can be accounted by the effective treatments received, a lead time bias, a dilution effect, a comorbid effect of other psychiatric diagnoses. & 2013 Elsevier Ireland Ltd. All rights reserved. Contents 1. Introduction ........................................................................................................ 267 2. Methods ........................................................................................................... 268 2.1. Search strategies .............................................................................................. 268 2.2. Selection criteria .............................................................................................. 268 2.3. Recorded variables ............................................................................................. 268 2.4. Statistical analysis ............................................................................................. 268 3. Results ............................................................................................................ 268 3.1. Retrieved sample .............................................................................................. 268 3.2. Definition of remission from a CHR state ........................................................................... 268 3.3. Remissions in the CHR state ..................................................................................... 269 3.4. Heterogeneity, publication bias, sensitivity and quality analyses ........................................................ 269 4. Discussion ......................................................................................................... 269 5. Conclusion ......................................................................................................... 270 References ............................................................................................................. 271 Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/psychres Psychiatry Research 0165-1781/$ - see front matter & 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.psychres.2013.03.004 n Corresponding author. Tel.: +44 77 8666 6570; fax +44 20 7848 0976. E-mail address: p.fusar@libero.it (P. Fusar-Poli). Psychiatry Research 209 (2013) 266–272