Pharmacotherapy and clinical characteristics of ultra-high-risk for psychosis according to conversion status: a naturalistic observational study

Aim: To explore the differences in pharmacotherapy and clinical characteristics of individuals at ultra-high-risk (UHR) for psychosis according to the conversion status, we analyzed the data for UHR patients seen at the Seoul Youth Clinic. Methods: This was a naturalistic observational study. We obtained clinical data, including demographic data, presenting complaint, duration of psychiatric symptoms, diagnosis and scores on clinical rating scales from individual records in the Seoul Youth Clinic. Prescription data were obtained from electronic medical records. Results: As of April 1, 2010, a total of 78 people were registered as being UHR for psychosis in the Seoul Youth Clinic. Patients commonly presented with paranoid ideas and anxiety. On entry to the Seoul Youth Clinic, 81% of the UHR group were diagnosed as having psychiatric disorders according to DSM-IV criteria. Of the 67 individuals who did not drop out of the Seoul Youth Clinic, 14 converted to psychosis. The mean time to conversion was 412 days post baseline examination. The mean duration of psychiatric symptoms before clinic presentation was shorter in the converter group than in the non-converter group. There were no differences in baseline scores on clinical rating scales between the two groups. Antipsychotics were commonly prescribed for UHR patients in the Seoul Youth Clinic, with the converter group exposed to antipsychotics for a longer period and at higher doses than the nonconverter group. Conclusions: In a naturalistic setting, the different pattern of exposure to antipsychotics between the converter and non-converter groups calls attention to the effects of antipsychotics on conversion to psychosis.