LAUSR

We read with interest the commentary by Buoli et al. [1], on our study “Long-term validity of the At Risk Mental State (ARMS) for predicting psychotic and non-psychotic mental disorders”, which was published in European Psychiatry [2]. In our prospective 6-year cohort study we followed up 710 individuals undergoing an assessment for a suspected Clinical High Risk state for Psychosis (CHR-P)3. We investigated their risk of developing psychotic and non-psychotic mental disorders. We concluded that the CHR-P designation [4] is not associated with an increased risk of developing mental disorders other than psychosis [3], replicating earlier independent findings [5]. Overall, we feel that critical appraisals of published studies such as the commentary by Buoli et al are greatly beneficial to the scientific advancement of knowledge in the field of the CHR-P state [3]. However, we also note some inaccuracies, that are discussed below. Firstly, Buoli et al note that “cognitive strategies” –which should rather have been referred to as cognitive behavioural therapieshave yielded hopeful results for the prevention of psychosis. This is not completely correct, given that the most recent network metaanalyses found no evidence for superior efficacy of any specific treatments compared to each other to prevent the onset of psychosis [6] or reduce the severity of symptoms [7] in CHR-P individuals. Secondly, Buoli et al argued that we have classified bipolar disorders with psychotic features as non-psychotic conditions. This is incorrect: as clearly indicated in our eMethods, our category of bipolar disorders included ICD-10 non-psychotic bipolar disorder (F31.x, excluding F31.2 and F31.5) and cyclothymia (F34.0) [3]. In our eMethods we have also provided the specific ICD-10 codes that were used to define the psychotic disorders that were considered as outcome in our prospective cohort analysis [3]. Conversely, Buoli et al presented some retrospective data taken from a sample of patients affected with psychotic and non-psychotic bipolar disorders but did not clarify whether ICD or DSM diagnoses were used nor the specific diagnostic types. Thirdly, there was some degree of conceptual confusion which was inherited by the retrospective vs prospective approach adopted by Buoli et al. The authors stated that, by retrospectively