Commentary: Time to abandon the 'clinical high risk state for psychosis' (CHR-P) concept in adolescence? Commentary on Frearson et al. 'Efficacy of preventative interventions for children and adolescents at clinical high risk of psychosis: A systematic review and meta-analysis of intervention studies'.

Abstract

There has been much academic interest in 'the clinical high risk for psychosis' (CHR-P) concept. Indeed, as two child and adolescent psychiatrists interested in psychosis prediction and prevention, we enthusiastically embraced the paradigm in our clinical and academic work. However, despite more than two decades of research, there is no definition of CHR-P in adolescence that has proven to be able to usefully predict transition to psychosis. Indeed, research suggests that much, if not all, of the risk associated with CHR diagnoses in adolescents is captured by being help-seeking for mental health problems, rather than being associated with a CHR diagnosis itself. In this commentary, we critique the systematic review by Frearson et al. (2025). In particular, we challenge the conceptualisation around the CHR-P concept, as applied to under 18 s, and the assumptions underpinning it. We also highlight issues with the terminology used when describing the experiences of young people categorised as being at CHR-P. Rather, we make the case for understanding and supporting help-seeking young people with distressing perceptual and ideational disturbance employing a needs-based, person-centred approach.