Response – Building on existing knowledge and redefining rather than abandoning the well‐established ‘clinical high risk for psychosis’ prevention paradigm

TL;DR

The paper argues for refining the clinical high risk for psychosis prevention model instead of abandoning it, emphasizing its importance in mental health.

Contribution

The paper proposes integrating precision medicine and transdiagnostic interventions to improve and expand the existing clinical high risk for psychosis paradigm.

Findings

The clinical high risk for psychosis paradigm is widely implemented and provides evidence-based interventions.

Negative symptoms in adolescents at clinical high risk for psychosis significantly impact functioning and outcomes.

Advancements in precision medicine can enhance risk stratification and intervention tailoring.

Abstract

We appreciate the commentary by Tiffin and Kelleher on our systematic review and meta‐analysis. The CHR‐P paradigm remains one of the most established preventive approaches in mental health. While concerns have been raised regarding the clinical utility of the CHR‐P paradigm, its implementation in specialized services worldwide supports its relevance. These services provide evidence‐based interventions, reducing unnecessary antipsychotic use and guiding treatment strategies. Tiffin and Kelleher's critique largely focuses on transition rates and age cutoffs. While we argue that transition rates in adolescents at CHR‐P are significant, other outcomes need to be considered. Among others, negative symptoms are clinically significant in adolescents at CHR‐P, impairing functioning and long‐term outcomes. We think we should refine and improve the CHR‐P paradigm rather than simply abandoning it. With advancements in precision medicine, we can improve risk stratification and tailor interventions to better serve individuals at risk. We can also expand the paradigm, so it supports other help‐seeking adolescents at risk requiring transdiagnostic, developmentally sensitive interventions to prevent psychosis.