{
  "abstract": "The Clinical High-Risk for Psychosis (CHR-P) paradigm underpins early detection strategies and informs the DSM-5 construct of Attenuated Psychosis Syndrome (APS), yet its discriminative predictive validity relative to CHR-P–negative help-seekers has not been systematically quantified. We conducted a systematic review and meta-analysis of longitudinal studies comparing transition to psychosis among help-seeking individuals according to CHR-P status. PubMed/MEDLINE and the Cochrane Library were searched from inception to June 22, 2026. Eligible studies included help-seeking samples assessed with validated CHR-P instruments and reporting psychosis transition outcomes separately for CHR-P-positive and CHR-P-negative participants. Random-effects meta-analyses estimated transition prevalence and relative risks (RRs), while heterogeneity, publication bias, and moderators were examined. 14 studies including 4477 participants (2220 CHR-P–positive and 2257 CHR-P–negative) met inclusion criteria. Estimated transition rates were 14.7% [95% CI, 9.7–21.7%) among CHR-P-positive individuals and 1.6% (95% CI, 0.8–3.2%) among CHR-P-negative individuals. CHR-P status was associated with an almost ten-fold increased risk of transition to psychosis (RR, 9.8; 95% CI, 4.5–21.82), with no significant moderation by follow-up duration or sample characteristics. These findings demonstrate strong discriminative and predictive validity of CHR-P criteria among help-seekers, supporting attenuated psychotic symptoms as a clinically meaningful pre-psychotic phenotype. Results support consideration of APS in DSM-6 within a prognostically grounded, stepped-care framework rather than as a categorical disorder.",
  "abstract_shown": true,
  "affiliations": [
    "Chair of Psychiatry, Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland",
    "Cantonal Sociopsychiatric Organisation, Mendrisio, Switzerland",
    "Department of Neuroscience, University of Turin, Turin, Italy",
    "Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Andrea Raballo",
      "orcid": "0000-0003-3709-4111"
    },
    {
      "affs": [
        2
      ],
      "name": "Antonio Preti"
    },
    {
      "affs": [
        3
      ],
      "name": "Michele Poletti",
      "orcid": "0000-0002-3306-8197"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/atkrzcxe1fahs.bib",
  "cited_by": 2,
  "doi": "10.1038/s41537-026-00785-4",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13745538/",
  "id": "atkrzcxe1fahs",
  "issns": [
    "2754-6993"
  ],
  "landing_url": "https://doi.org/10.1038/s41537-026-00785-4",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Review Article"
    ],
    [
      "openalex",
      "2738|Schizophrenia research and treatment"
    ]
  ],
  "openalex": "W7168634753",
  "pdf_url": "https://www.nature.com/articles/s41537-026-00785-4_reference.pdf",
  "pmcid": "PMC13745538",
  "pmid": "42463671",
  "published": "2026-07-16",
  "publisher": "Nature Publishing Group",
  "ris": "https://research.draconitic.com/paper/atkrzcxe1fahs.ris",
  "sources": [
    {
      "first_seen": "2026-11-11T12:23:04Z",
      "native_id": "PMC13745538",
      "source": "pmc",
      "url": "https://doi.org/10.1038/s41537-026-00785-4"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2738|Schizophrenia research and treatment",
      "subfield": "psychiatry"
    }
  ],
  "title": "Discriminative validity of Clinical High-Risk Status for Psychosis among help-seekers: a systematic review and meta-analysis",
  "title_text": "Discriminative validity of Clinical High-Risk Status for Psychosis among help-seekers: a systematic review and meta-analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-11-12T12:22:01Z",
  "url": "https://research.draconitic.com/paper/atkrzcxe1fahs",
  "venue": "Schizophrenia",
  "versions": []
}