Response – Building on existing knowledge and redefining rather than abandoning the well-established ‘clinical high risk for psychosis’ prevention paradigm: Commentary on Tiffin and Kelleher “Time to abandon the ‘clinical high risk state for psychosis” (CHR-P) concept in adolescence?”

TY - JOUR

T1 - Response – Building on existing knowledge and redefining rather than abandoning the well-established ‘clinical high risk for psychosis’ prevention paradigm

T2 - Commentary on Tiffin and Kelleher “Time to abandon the ‘clinical high risk state for psychosis” (CHR-P) concept in adolescence?”

AU - Salazar de Pablo, Gonzalo

AU - Aymerich, Claudia

AU - Frearson, Grace

AU - de Otazu Olivares, Javier

AU - Catalan, Ana

N1 - Publisher Copyright: © 2025 The Author(s). Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

PY - 2025/11

Y1 - 2025/11

N2 - 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.

AB - 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.

KW - clinical high risk for psychosis

KW - evidence

KW - Prevention

UR - https://www.scopus.com/pages/publications/105000771075

U2 - 10.1111/camh.12777

DO - 10.1111/camh.12777

M3 - Comment/debate

AN - SCOPUS:105000771075

SN - 1475-357X

VL - 30

SP - 405

EP - 407

JO - Child and Adolescent Mental Health

JF - Child and Adolescent Mental Health

IS - 4

ER -