Transition to psychosis during the COVID-19 pandemic: a real-world study of conversion rates in individuals with attenuated psychotic symptoms

Objective The COVID-19 pandemic caused widespread disruptions, affecting healthcare systems, social dynamics, and mental well-being. However, its impact on psychosis remains a subject This study examines psychosis transition rates and associated psychopathology among individuals at clinical high-risk for psychosis (CHR-P) with attenuated psychotic symptoms (APS) during the COVID-19 pandemic in Italy. Methods This retrospective study analyzed 12-month longitudinal data from 27 individuals with APS enrolled from April 2020 to April 2021. The participants’ age was 22.18±3.58 years; fourteen were females; eight reported cannabis use; fourteen resided in urban areas; none had prior or current antipsychotic treatment. The transition to psychosis was assessed using the Structured Interview for Psychosis-Risk Syndromes (SIPS/SOPS) criteria. The Aberrant Salience Inventory (ASI) was administered at baseline to assess abnormal salience processing. Results After one year, eight subjects (29.63%) transitioned to psychosis. Sociodemographic characteristics and known risk factors of the transition to psychosis, such as cannabis use and urbanicity, did not significantly differ between those who transitioned (Converters) and those who did not (Non-Converters). Baseline ASI scores were significantly higher in Converters. Linear Mixed Model analysis revealed a worsening of symptoms over time in Converters. Conclusions This study evaluated the conversion rate to full-blown psychosis during the COVID-19 pandemic in an Italian cohort of CHR-P, revealing, after one year, a higher psychosis transition rate compared to pre-pandemic levels (approximately 30% vs. 15%). These findings highlight the need for further research into the impact of the COVID-19 pandemic on psychosis and the mechanisms underlying these transitions.