Jai Shah1,2,3, Rachel Rosengard3, Sarah McIlwaine1,2, Srividya Iyer1,2, Sally Mustafa1, Ridha Joober1,2, Martin Lepage1,2,3, Ashok Malla1,2; 1Department of Psychiatry, McGill University, Montréal, Canada, 2PEPP-Montréal, Douglas Mental Health University Institute, Montréal, Canada, 3Integrate Program in Neuroscience, McGill University, Montréal, Canada
PURPOSE: The widespread operationalization of the clinical high-risk (CHR) phase and its clear vulnerability for a first episode of psychosis (FEP) have led to a much-needed focus on factors related to conversion from CHR to FEP. Yet they have also resulted in an assumption which has gone largely unexamined: that CHR invariably precedes FEP. We examined this assumption, and whether key treatment and service outcomes in FEP services vary depending on whether or not subjects experienced a pre-onset CHR state. METHODS: Retrospective information was systematically extracted regarding sociodemographic characteristics, psychiatric/behavioral changes, and help-seeking in 200 FEP patients (aged 14-35) receiving specialized early intervention services in Montreal, Canada. Individuals were then followed for 1 year in order to assess individual- and service-level outcomes. RESULTS: At intake to FEP services, 68% of youth recalled a pre-onset CHR syndrome while 32% did not; these groups showed no sociodemographic or clinical differences at baseline. However, duration of untreated psychosis was significantly longer in those with prior CHR syndromes (U=3315, p=0.043). Furthermore, symptomatic and functional outcomes were poorer for the prior CHR subgroup in positive symptoms (SAPS group effect, F[1,198]=4.79, p=0.03), with significant group-by-time interactions for negative symptoms (SANS, F[1,198]= 5.67, p=0.018), global functioning (GAF, F[1,198]=7.96, p=0.005), and social/occupational functioning (SOFAS, F[1,198]=4.392, p=0.037). CONCLUSIONS: Most FEP patients experience pre-onset CHR syndromes, enduring greater delays in accessing treatment and poorer longitudinal outcomes than those without prior CHR symptoms. These findings strongly argue for the personalization of early intervention efforts based on knowledge regarding trajectories to FEP.
