Antipsychotic treatment in clinical high risk for psychosis: Iatrogenesis related to dopamine supersensitivity psychosis?

Zhang et al. (2020) conducted a 3-year longitudinal study of the effectiveness of
antipsychotics (AP) on preventing transition for clinical high risk (CHR) for psychosis patients in developing psychosis. Their findings showed AP had no benefit in preventing transition in this CHR population. In fact, among the 450 follow-up CHR patients, those who had received antipsychotic medication (n=309) had significantly higher psychosis transition rates compared to those
who had not (26.9% vs 17.7%). The psychosis transition rate for mild, but not
severe CHR cases was significantly elevated. Antipsychotic treatment (APT)
predicted transition independent of symptoms, despite similar functional levels of CHR patients with and without AP. Thus, the results do not support the
hypothesis raised by Raballo et al. (2021) that CHR patients commenced on APT
may be more vulnerable for transition to psychosis on the basis of poorer levels of functioning.