Clinical Course of Individuals at Clinical High Risk for Psychosis: Transition or Remission

Patients with psychoses often show various symptoms and signs before their onset of illnesses including developmental delay during childhood and adolescence, cognitive impairments such as impaired attention, mood symptoms such as depressed mood or mood fluctuation, anxiety symptoms, sleep problems, and functional impairments such as decline in academic or social functions. This period can also show psychosis-related symptoms such as attenuated forms of psychotic symptoms or full psychotic symptoms with limited duration falling short of diagnostic criteria of psychoses. When an individual is prospectively thought to be in this “prodromal” state of psychoses, the individual is regarded to be at clinical high risk for psychosis (CHR). Naturally, some of the individuals at CHR experience a psychotic transition during their clinical course, but the others show much diverse clinical course including improvement of symptoms, remission of symptoms, emergence or persistence of non-psychotic co-morbid illnesses, and various alterations of functional level. It is reported that the majority of individuals at CHR do not experience psychotic conversion but show diverse clinical courses otherwise. Although the state of CHR has numerous aspects to investigate, this review will focus on various clinical courses of individuals at CHR, including psychotic transition and remission.