Effect of Early Intervention Program Enrollment on CHR/UHR Transition to Psychosis

confidence: high · 1 sources

What the evidence says

One tier-A prospective cohort study of 125 ultra-high-risk (UHR) individuals in an early intervention program supplies all three claims on this page. Within that cohort, 25% of participants (31 of 125) reached the psychometric threshold for conversion to psychosis on the BPRS within the first 2 years of treatment — a descriptive rate, not a comparison against a non-enrolled group.

Within the same cohort, individuals who received antipsychotic prescriptions during the first 2 years of treatment were more likely to reach that conversion threshold: hazard ratio 3.03 (95% CI 1.49–6.16), p = .003, from a Cox proportional-hazards survival analysis. The source treats this as associational rather than causal, and flags an open question: whether antipsychotic prescription is itself a driver of conversion, or simply a marker that a patient was already more symptomatic.

That ambiguity is not resolved by the data on this page — if anything, it is sharpened. The same cohort shows that UHR individuals who received antipsychotics had higher BPRS scores than those who did not, at baseline, at 6 months, and at 18 months, which the source interprets as those patients being "modestly more severe at inception" and staying more symptomatic through the study period. This means the elevated hazard ratio for conversion among the prescribed group runs alongside a pre-existing severity gap between the two groups, measured at three separate timepoints.

None of the claims here compare conversion rates between UHR individuals enrolled in an early intervention program and UHR individuals who were not enrolled, or who received treatment as usual. The 25% figure and the HR of 3.03 are both generated from within a single enrolled cohort. The effect of program enrollment itself, relative to no enrollment, is not addressed by these sources — what is measured is a within-cohort predictor (antipsychotic prescription) of conversion, not a between-cohort effect of the program.

Where the evidence splits

No contradictions in the current sources.

Thresholds and dose-response

No threshold established in the current sources.

Open empirical questions

What conversion rate would be observed among UHR individuals not enrolled in an early intervention program, or receiving treatment as usual — no comparison arm appears in these sources.
Whether antipsychotic prescription causally increases conversion risk or is only a marker of pre-existing symptom severity — the source itself leaves this open.
What specific BPRS score value constitutes the "psychometric threshold" for conversion — the claims reference the threshold without stating the cutoff score.
Whether the HR of 3.03 and the 25% conversion rate generalize beyond this single 125-person cohort.

Findings

Antipsychotic prescription during the first 2 years of UHR treatment is associated with increased hazard of conversion to psychosis

confidence — direction: highconfidence — magnitude: highconsensus: thin — single tier-A prospective cohort study

mechanism: not established — the source raises but does not resolve whether prescription is a causal factor in conversion or a marker of pre-existing symptom severity
effect: increased hazard, HR 3.03 (95% CI 1.49–6.16), p = .003
conditions / moderators: measured within a single UHR cohort under early intervention treatment; co-occurs with a baseline severity gap between prescribed and unprescribed subgroups (see below) — not established as independent of that gap

Antonio Preti (2021), Early Intervention in Psychiatry · doi:10.1111/eip.13158 · https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/eip.13158 (retrieved 2026-08-16)

UHR participants in an early intervention program reach the psychometric conversion threshold at a rate of 25% within 2 years

confidence — direction: highconfidence — magnitude: highconsensus: thin — single study

mechanism: not established — descriptive base rate, no non-enrolled comparison group in the source
effect: 25% conversion rate (31 of 125 participants) within 2 years
conditions / moderators: single tier-A prospective cohort of UHR individuals in early intervention treatment

Antonio Preti (2021), Early Intervention in Psychiatry · doi:10.1111/eip.13158 · https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/eip.13158 (retrieved 2026-08-16)

UHR individuals who received antipsychotics show higher BPRS symptom severity than those who did not

confidence — direction: highconfidence — magnitude: highconsensus: thin — single study

mechanism: not established — could reflect severity-based selection into antipsychotic prescription, or a treatment effect on symptom trajectory
effect: increases — higher BPRS scores in the antipsychotic-prescribed group at baseline, at 6 months, and at 18 months (no numeric score values stated in the source)
conditions / moderators: observational group comparison within the same UHR cohort

Antonio Preti (2021), Early Intervention in Psychiatry · doi:10.1111/eip.13158 · https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/eip.13158 (retrieved 2026-08-16)