Clinical High-Risk for Psychosis in Adolescents: Updated Meta-Analysis on Transition Rates and Antipsychotic Prognostic Value.
The clinical high-risk for psychosis (CHR-P) paradigm has been widely applied in youth mental health, yet its prognostic validity in minors remains debated. This study aimed to provide an updated meta-analysis of transition rates to psychosis in children and adolescents at CHR-P, and to assess the influence of baseline antipsychotic (AP) exposure on transition outcomes.
We conducted a systematic review and meta-analysis following PRISMA guidelines (PROSPERO CRD420251064505). PubMed/MEDLINE and the Cochrane Library were searched through August 30, 2025. Eligible studies included participants ≤18 years or samples with mean age <18 years, defined CHR-P status with validated instruments, and reported longitudinal data on transition to psychosis. Transition prevalences were pooled using random-effects models. Subgroup analyses evaluated the impact of baseline AP exposure.
Thirty-two independent cohorts were included, comprising 2951 CHR-P individuals, almost all in adolescence. Across studies restricted to minors, overall transition converged at ∼16-17%, while broader samples with mean age <18 years but including young adults reached ∼23%, approximating adult CHR-P estimates (∼25%). Baseline AP exposure was consistently associated with a higher risk of transition (risk ratio ≈1.5), supporting its role as a negative prognostic factor.
CHR-P criteria demonstrate prognostic validity in developmental populations, with transition rates in adolescents comparable to young adult cohorts and significantly higher than in CHR-P negative adolescents. In line with previous research in adult CHR-P, the need of AP at baseline is substantially associated with an increased risk for transition. Future research should broaden prognostic focus beyond transition alone to capture remission, persistence, and functional outcomes in this vulnerable group.
We conducted a systematic review and meta-analysis following PRISMA guidelines (PROSPERO CRD420251064505). PubMed/MEDLINE and the Cochrane Library were searched through August 30, 2025. Eligible studies included participants ≤18 years or samples with mean age <18 years, defined CHR-P status with validated instruments, and reported longitudinal data on transition to psychosis. Transition prevalences were pooled using random-effects models. Subgroup analyses evaluated the impact of baseline AP exposure.
Thirty-two independent cohorts were included, comprising 2951 CHR-P individuals, almost all in adolescence. Across studies restricted to minors, overall transition converged at ∼16-17%, while broader samples with mean age <18 years but including young adults reached ∼23%, approximating adult CHR-P estimates (∼25%). Baseline AP exposure was consistently associated with a higher risk of transition (risk ratio ≈1.5), supporting its role as a negative prognostic factor.
CHR-P criteria demonstrate prognostic validity in developmental populations, with transition rates in adolescents comparable to young adult cohorts and significantly higher than in CHR-P negative adolescents. In line with previous research in adult CHR-P, the need of AP at baseline is substantially associated with an increased risk for transition. Future research should broaden prognostic focus beyond transition alone to capture remission, persistence, and functional outcomes in this vulnerable group.