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Lessons learned from the psychosis high-risk state: towards a general staging model of prodromal intervention

Published online by Cambridge University Press:  18 February 2013

P. Fusar-Poli ,
A. R. Yung ,
P. McGorry  and
J. van Os
P. Fusar-Poli*
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's College London and OASIS Team, South London and the Maudsley NHS Foundation Trust, London, UK
A. R. Yung
Affiliation:
Institute of Brain, Behaviour and Mental Health, University of Manchester, UK Orygen Youth Health Research Centre and Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
P. McGorry
Affiliation:
Orygen Youth Health Research Centre and Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
J. van Os
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, King's College London and OASIS Team, South London and the Maudsley NHS Foundation Trust, London, UK Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, The Netherlands Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
*
*Address for correspondence: Dr P. Fusar-Poli, Department of Psychosis Studies, Box PO63, Institute of Psychiatry, 16 De Crespigny Park, London SE5 8AF, UK. (Email: p.fusar@libero.it)
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Abstract

Background

The past two decades have seen exponential clinical and research interest in help-seeking individuals presenting with potentially prodromal symptoms for psychosis. However, the epidemiological validity of this paradigm has been neglected, limiting future advancements in the field.

Method

We undertook a critical review of core epidemiological issues underlying the clinical high-risk (HR) state for psychosis and which model of prodromal intervention is best suited for mental health.

Results

The HR state for psychosis model needs refining, to bring together population-based findings of high levels of psychotic experiences (PEs) and clinical expression of risk. Traditionally, outcome has been attributed to ‘HR criteria’ alone rather than taking into account sampling strategies. Furthermore, the exclusive focus on variably defined ‘transition’ obscures true variation in the slow and non-linear progression across stages of psychopathology. Finally, the outcome from HR states is variable, indicating that the underlying paradigm of ‘schizophrenia light progressing to schizophrenia’ is inadequate.

Conclusions

In the general population, mixed and non-specific expression of psychosis, depression, anxiety and subthreshold mania is common and mostly transitory. When combined with distress, it may be considered as the first, diagnostically neutral stage of potentially more severe psychopathology, which only later may acquire a degree of diagnostic specificity and possible relative resistance to treatment. Therefore, rather than creating silos of per-disorder ultra-HR syndromes, an early intervention focus on the broad syndrome of early mental distress, requiring phase-specific interventions, may be more profitable.

Keywords

High riskprodromalpsychosispsychotic experiencesschizophrenia
Type
Review Article
Information
Psychological Medicine , Volume 44 , Issue 1 , January 2014 , pp. 17 - 24
Copyright
Copyright © Cambridge University Press 2013 

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