A Clinical Perspective on Multidimensional Assessment of Clinical High-Risk States for Psychosis Beyond Transition Prediction

Background: Clinical high-risk states for psychosis (CHR-P) are associated with heterogeneous symptomatic and functional outcomes, only one of which is transition to psychosis. Objective: To propose a structured approach to current care needs and longitudinal clinical formulation alongside established syndromic assessment. Methods: This perspective integrates a targeted, non-systematic appraisal of instrument studies, evidence syntheses, longitudinal cohorts, and guidance with an explicitly author-proposed assessment architecture. Supplementary PubMed searches conducted during revision have been reported separately from the original search. Results: The framework retains validated CHR-P interviews as the syndromic anchor and organizes symptoms, functioning, cognition, comorbidity, developmental context, and longitudinal change into descriptive clinical profiles. A minimal clinical dataset is distinguished from optional structured assessments and investigational biological or digital measures. Descriptive profiles document source measures, current burden, change, and uncertainty without numerical weighting. A staged validation program prioritizes reproducibility, feasibility, and functioning, with transition assessed separately. Conclusions: The current framework offers a candidate structure for documenting needs and discussing care priorities; it does not establish prognostic accuracy or treatment benefit. Prospective evaluation is required before profile-based decisions based on this interpretative model can be recommended. A clinically useful approach to CHR-P research may need to move beyond reductionist conversion/non-conversion predictive models toward more calibrated, externally validated paradigms capable of predicting multiple clinically meaningful trajectories.