Disorder, not just state of risk: meta-analysis of functioning and quality of life in people at high risk of psychosis

Background The nosology of the psychosis high-risk state is controversial. Traditionally conceived as an 'at risk' state for the development of psychotic disorders, it is also conceptualised as a clinical syndrome associated with functional impairment. Aims To investigate meta-analytically the functional status of patients at high clinical risk for psychosis and its association with longitudinal outcomes. Method Three meta-analyses compared level of functioning (n = 3012) and quality of life (QoL) (n = 9 45) between a high-risk group, a healthy control group and group with psychosis, and baseline functioning in people in the high-risk group who did or did not have a transition to psychosis at follow-up (n=654). Results People at high risk had a large impairment in functioning (P<0.001) and worse QoL (P=0.001) than the healthy control group, but only small to moderately better functioning (P=0.012) and similar QoL (P=0.958) compared with the psychosis group. Among the high-risk group, those who did not develop psychosis reported better functioning (P=0.001) than those who did. Conclusions Our results indicate that the high-risk state is characterised by consistent and large impairments of functioning and reduction in QoL similar to those in other coded psychiatric disorders. Copyright and usage (C) The Royal College of Psychiatrists 2015.