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Volume 14
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10.3390/jcm14155432
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Review

Targeting Psychotic and Cognitive Dimensions in Clinical High Risk for Psychosis (CHR-P): A Narrative Review

by
Michele Ribolsi
1,
Federico Fiori Nastro
2,3,*,
Martina Pelle
2,4,
Eleonora Esposto
2,
Tommaso B. Jannini
2 and
Giorgio Di Lorenzo
2,3
1
Department of Life Science, Health, and Health Professions, Link Campus University, 00165 Rome, Italy
2
Department of Systems Medicine, Tor Vergata University of Rome, 00133 Rome, Italy
3
IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
4
Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(15), 5432; https://doi.org/10.3390/jcm14155432 (registering DOI)
Submission received: 22 June 2025 / Revised: 24 July 2025 / Accepted: 30 July 2025 / Published: 1 August 2025
(This article belongs to the Section Mental Health)
Versions Notes

Abstract

Schizophrenia (SCZ) is a debilitating disorder with substantial societal and economic impacts. The clinical high risk of psychosis (CHR-P) state generally precedes the onset of SCZ, offering a window for early intervention. However, treatment guidelines for CHR-P individuals remain contentious, particularly regarding antipsychotic (AP) medications. Although several studies have examined the effects of APs on reducing the risk of conversion to psychosis, the novelty of this narrative review lies in its focus on differentiating APs’ effects on positive and negative symptoms, as well as cognitive functioning, in CHR-P individuals. Evidence suggests that APs may be cautiously recommended for attenuated positive symptoms to stabilize individuals for psychological interventions, but their use in treating negative symptoms is generally discouraged due to limited efficacy and potential side effects. Similarly, the effects of APs on cognitive abilities remain underexplored, with results indicating a lack of significant neurocognitive outcomes. In conclusion, APs’ use in CHR-P patients requires careful consideration due to limited evidence and potential adverse effects. Future research should focus on individual symptom domains and treatment modalities to optimize outcomes in this critical population. Until then, a cautious approach emphasizing non-pharmacological interventions is advisable.
Keywords: antipsychotics; UHR; CHR-P; clinical high risk of psychosis; ultra-high risk of psychosis; positive symptoms; negative symptoms; cognitive abilities antipsychotics; UHR; CHR-P; clinical high risk of psychosis; ultra-high risk of psychosis; positive symptoms; negative symptoms; cognitive abilities

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MDPI and ACS Style

Ribolsi, M.; Fiori Nastro, F.; Pelle, M.; Esposto, E.; Jannini, T.B.; Di Lorenzo, G. Targeting Psychotic and Cognitive Dimensions in Clinical High Risk for Psychosis (CHR-P): A Narrative Review. J. Clin. Med. 2025, 14, 5432. https://doi.org/10.3390/jcm14155432

AMA Style

Ribolsi M, Fiori Nastro F, Pelle M, Esposto E, Jannini TB, Di Lorenzo G. Targeting Psychotic and Cognitive Dimensions in Clinical High Risk for Psychosis (CHR-P): A Narrative Review. Journal of Clinical Medicine. 2025; 14(15):5432. https://doi.org/10.3390/jcm14155432

Chicago/Turabian Style

Ribolsi, Michele, Federico Fiori Nastro, Martina Pelle, Eleonora Esposto, Tommaso B. Jannini, and Giorgio Di Lorenzo. 2025. "Targeting Psychotic and Cognitive Dimensions in Clinical High Risk for Psychosis (CHR-P): A Narrative Review" Journal of Clinical Medicine 14, no. 15: 5432. https://doi.org/10.3390/jcm14155432

APA Style

Ribolsi, M., Fiori Nastro, F., Pelle, M., Esposto, E., Jannini, T. B., & Di Lorenzo, G. (2025). Targeting Psychotic and Cognitive Dimensions in Clinical High Risk for Psychosis (CHR-P): A Narrative Review. Journal of Clinical Medicine, 14(15), 5432. https://doi.org/10.3390/jcm14155432

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