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What Protects Patients at Risk for Psychosis? A Long-Term Follow-up Study

English title What Protects Patients at Risk for Psychosis? A Long-Term Follow-up Study
Applicant Riecher-Rössler Anita
Number 159554
Funding scheme Project funding (Div. I-III)
Research institution Zentrum für Gender Research u. Früherkennung Universitäre Psychiatrische Kliniken Basel Universitätsspital Basel
Institution of higher education University of Basel - BS
Main discipline Neurology, Psychiatry
Start/End 01.07.2015 - 30.06.2017
Approved amount 218'000.00
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All Disciplines (2)

Neurology, Psychiatry
Mental Disorders, Psychosomatic Diseases

Keywords (12)

schizophrenia; ultra-high risk (UHR); risk factors; resilience; neurocognition; long-term follow-up; psychosis; stigmatization; psychopathology; protective factors; neuroimaging; at-risk mental state (ARMS)

Lay Summary (German)

Die Früherkennung von Psychosen schon in ihren Vorstadien ist zu einem weithin akzeptierten Ziel der Psychiatrie geworden, da eine frühe Behandlung schon vor dem Ausbruch des Vollbilds einer Psychose Verlauf und Prognose entscheidend verbessern kann.Es entwickeln jedoch nur ca. 30% der identifizierten Psychoserisiko-Patienten tatsächlich das Vollbild einer Psychose. Über die verbleibenden ca. 70% sind kaum ausreichend Information über Verlauf und Entwicklung vorhanden. Auch wurde mehrfach die Befürchtung geäussert, dass die Abklärung und Behandlung in einem psychiatrischen Zentrum sowie die Information über ein Psychoserisiko zu Stigmatisierung und Verunsicherung führe.
Lay summary

Inhalt und Ziele des Forschungsprojekts

Diese Studie hat zum Ziel, den Langzeitverlauf  der Patienten zu erforschen, die keine Psychose entwickelt haben. Wie viele dieser Patienten sind wieder ganz gesund geworden, wie viele haben andere psychische Erkrankungen entwickelt, und welche Faktoren haben den Verlauf positiv beeinflusst?

Weiterhin sollen Veränderungen des sozialen Funktionsniveaus, der kognitiven Fähigkeiten und Gehirnstruktur sowie deren Wechselwirkungen im Langzeitverlauf untersucht werden. Auch wird diese Studie erstmals empirisch die Frage beantworten, ob die Abklärung und Behandlung im Früherkennungszentrum von den Patienten als eher hilfreich oder belastend erlebt wird.

Wissenschaftlicher und gesellschaftlicher Kontext des Forschungsprojekts

Diese Studie ist  eine der ersten Studien weltweit, die eine grosse Anzahl von Psychoserisikopatienten über einen längeren Zeitraum auf mehreren Ebenen gleichzeitig untersucht. Indem Einflussfaktoren des Krankheitsverlaufs erforscht werden, trägt die Studie dazu bei, die Behandlung bzw. Prävention von Psychosen zukünftig zu verbessern.

Direct link to Lay Summary Last update: 05.05.2015

Responsible applicant and co-applicants



Long-term rates of remission and late psychotic transition of individuals at risk for psychosis
Beck K., Andreou C., Studerus E., Egloff L., Heitz U., Menghini-Müller S., Ittig S., Leanza L., Uttinger M., Simon A., Borgwardt S., Riecher-Rössler A. (2017), Long-term rates of remission and late psychotic transition of individuals at risk for psychosis, in European Psychiatry, 41(Supplement), S186-S186.


Group / person Country
Types of collaboration
Prof. Patrick McGorry, Centre for Youth Mental Health, The University of Melbourne Australia (Oceania)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Prof. Norman Sartorius, 14 chemin Colladon, 1209 Geneva, Switzerland Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Prof. Phillip McGuire, Institute of Psychiatry - King`s College London Great Britain and Northern Ireland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Prof. Michaela Amering, Ludwig Boltzmann Institut für Sozialpsychiatrie, Vienna Austria (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
25th European Congress of Psychiatry (EPA) Poster Long-term rates of remission and late psychotic transition of individuals at risk for psychosis 01.04.2017 Florenz, Italy Borgwardt Stefan; Simon Andor; Riecher-Rössler Anita; Beck Katharina;


Title Year
EPA 2017 Best e-Poster Award 2017

Associated projects

Number Title Start Funding scheme
57216 Prediction and early detection of schizophrenia - a prospective multilevel approach 01.03.2000 Project funding (Div. I-III)
119382 Brain structural and neurofunctional correlates of liability to psychosis 01.04.2008 Ambizione


Background:Previous research on early stages of psychosis has mainly focused on determining the risk of developing full-blown psychosis in at-risk mental state (ARMS) individuals and predicting the transition to psychosis. However, relatively few information is available on the disease trajectories in ARMS individuals not developing psychosis (so called false positives or ARMS-Non-Transition [ARMS-NT]) even though such individuals usually make up the largest part of ARMS samples. Furthermore, there have been very heated debates about potentially harming those who were falsely identified as having a risk, mainly by stigmatization.Objectives: The primary aim of the proposed study is to investigate the long-term outcome of ARMS individuals that were originally identified as being at risk for psychosis in the Früherkennung von Psychosen (FePsy) project and the Bruderholz study (BHS), but did not develop frank psychosis during the initial follow-up periods of these research projects. We are specifically interested in rates of remission from ARMS and in identifying resilience factors predicting remission from ARMS.Secondary aims of the proposed study are a) to investigate longitudinal changes in psychopathology, psychosocial functioning, brain structure, and neurocognition, including the interdependencies of these changes; b) to study the development of other psychiatric diseases over time; and c) to find out about individuals’ experience of being informed of having a risk for psychosis and potential consequences, such as stigmatization.Hypotheses: Primary hypotheses:-ARMS individuals who did not develop frank psychosis during the first follow-up period of the above named projects can be divided into three outcome groups a) those that have remitted from their risk state (ARMS-R), b) those who suffer from a persisting at-risk mental state (ARMS-P), and c) those with a very late transition to psychosis (ARMS-T). Based on previous studies [2-4], we expect the latter group to be only small and the ARMS-R and ARMS-P groups about equal in size.-The likelihood of having a remission from an ARMS is predicted by demographic variables (such as age and gender), illness factors at baseline (such as less severe psychopathology, cognitive and functional impairment, and brain structural changes), but also by resilience and protective factors during follow-up (such as good coping and social support, adherence to treatment, and lack of drug abuse).Secondary hypotheses:-Remission from ARMS psychopathology is associated with improvements of neurocognition and social functioning.-Preservation of brain structure over time (i.e. no loss of grey matter volume) is associated with a better course regarding psychopathology, neurocognition and social functioning.-Some patients have developed other psychiatric disorders (apart from ARMS or psychosis)-Being educated about having a risk for psychosis and getting help is experienced by most ARMS individuals as more helpful than harmful.Design and Methods: Study sample: In this long term follow-up study, we will examine individuals with an ARMS for psychosis, who have originally been identified within the FePsy project in Basel from March 2000 to February 2012 (n = 118) and within BHS study in the canton of Baselland from January 2003 to December 2006 (n = 99). During the first short follow-up periods, 30 and 10 of the ARMS individuals developed frank psychosis in the FePsy and BHS studies, respectively. All other ARMS individuals, i.e. those without transition to psychosis or those lost during the first follow-up periods, will be asked to take part (n = 177).They will be assessed regarding the following outcome measures:-Primary outcome: remission from ARMS, including time to remission-Secondary outcomes: a) neurocognition; b) structural MRI; c) general, social and occupational functioning; d) DSM-IV axis I diagnoses; e) patients’ subjective experience of being informed to have a risk for psychosis and of potential stigmatization. Apart from self-report and observer ratings, patient records (case notes etc.) of the period concerned will be collected. Statistical analyses: The obtained data will be analyzed in cross-sectional analyses and in combination with existing data in longitudinal and time-to-event analyses. For prediction of time to remission/transition, we will use a proportional cause-specific hazards model, as well as automated pattern recognition methods, such as random survival forest.Expected value of the project: To the best of our knowledge, this is the first study on ARMS-individuals who do not make a transition to psychosis (ARMS-NT) within a short period with a) a follow up period of up to 14 years b) a multi-domain assessment and at the same time c) investigation about individuals’ subjective experience of being informed about their risk and potential stigmatization.