Clinical High-Risk for Psychosis in Adolescents: Updated Meta-analysis on Transition Rates and Antipsychotic...

Area of Science:

• Child and Adolescent Psychiatry
• Psychosis Risk Research
• Mental Health Prognostics

Background:

• The clinical high-risk for psychosis (CHR-P) paradigm is used in youth mental health.
• Prognostic validity of CHR-P in minors requires further investigation.
• Antipsychotic (AP) exposure is a potential factor influencing CHR-P outcomes.

Purpose of the Study:

• To conduct an updated meta-analysis of psychosis transition rates in children and adolescents meeting CHR-P criteria.
• To evaluate the impact of baseline antipsychotic (AP) exposure on transition outcomes in this population.

Main Methods:

• Systematic review and meta-analysis adhering to PRISMA guidelines.
• Searched PubMed/MEDLINE and Cochrane Library up to August 30, 2025.
• Included studies with participants ≤18 years or mean age <18 years, using validated CHR-P instruments and reporting longitudinal transition data.
• Pooled transition prevalences using random-effects models and conducted subgroup analyses for AP exposure.

Main Results:

• Included 32 independent cohorts with 2951 CHR-P individuals, predominantly adolescents.
• Overall transition rates were ~16-17% in studies restricted to minors and ~23% in broader samples including young adults.
• Baseline AP exposure was associated with a significantly higher risk of transition (risk ratio ≈1.5).

Conclusions:

• CHR-P criteria show prognostic validity in developmental populations, with adolescent transition rates comparable to young adults.
• Baseline AP use is a significant negative prognostic factor, increasing transition risk.
• Future research should expand prognostic focus to include remission, persistence, and functional outcomes.