Risk-Stratified Tiered Intervention Among Chinese Clinical High-Risk for Psychosis Patients and Attenuated Negative Symptoms as a Predictor of 1-Year Psychosis Conversion: A Retrospective Propensity-Matched Real-World Cohort Study.

OBJECTIVE: This retrospective propensity-score-matched real-world cohort study aimed to evaluate the clinical efficacy of risk stratification combined with tiered intervention in young Chinese patients at clinical high-risk (CHR) for psychosis, and to explore whether attenuated negative symptoms could independently predict 1-year conversion to overt psychosis. METHODS: A total of 150 CHR patients receiving risk-stratified tiered management were enrolled as the intervention group, and 75 CHR patients receiving conventional routine care were matched as the control group via propensity-score matching (PSM). All participants completed standardized two-stage clinical screening, cranial MRI to exclude organic brain lesions, and systematic symptom and functional assessments. Logistic regression and receiver-operating-characteristic (ROC) curve analyses were performed to identify independent predictors of psychosis conversion, with a specific focus on attenuated negative symptoms. Primary outcomes included 1-year psychosis conversion rate, changes in global functioning, and treatment adherence. RESULTS: After 1-year follow-up, the intervention group showed a significantly lower psychosis conversion rate (9.3% vs 20.0%, P=0.021), greater improvement in global functioning (mean Δ = 9.8 vs 4.0, P < 0.001), and higher treatment adherence (78% vs 40%, P < 0.001) relative to the PSM-matched control group. Multivariate logistic regression identified severe attenuated negative symptoms as an independent risk-associated factor for 1-year psychosis conversion (OR = 2.71, 95% CI: 1.43-5.14, P < 0.01). The ROC-AUC of attenuated negative symptoms for predicting psychosis conversion was 0.79, indicating acceptable predictive performance. CONCLUSION: Risk stratification paired with tiered intervention reduced the risk of psychosis transition, improved global social functioning, and enhanced treatment adherence among Chinese CHR patients within this real-world cohort. Attenuated negative symptoms represent a reliable independent predictor of 1-year psychosis conversion and may be integrated into routine clinical risk assessment to support targeted early-intervention strategies for CHR populations.