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Open AccessJournal ArticleDOI

The Psychosis High-Risk State: A Comprehensive State-of-the-Art Review

TLDR
The relatively new field of HR research in psychosis has the potential to shed light on the development of major psychotic disorders and to alter their course and provides a rationale for service provision to those in need of help who could not previously access it.
Abstract
Context During the past 2 decades, a major transition in the clinical characterization of psychotic disorders has occurred. The construct of a clinical high-risk (HR) state for psychosis has evolved to capture the prepsychotic phase, describing people presenting with potentially prodromal symptoms. The importance of this HR state has been increasingly recognized to such an extent that a new syndrome is being considered as a diagnostic category in the DSM-5. Objective To reframe the HR state in a comprehensive state-of-the-art review on the progress that has been made while also recognizing the challenges that remain. Data Sources Available HR research of the past 20 years from PubMed, books, meetings, abstracts, and international conferences. Study Selection and Data Extraction Critical review of HR studies addressing historical development, inclusion criteria, epidemiologic research, transition criteria, outcomes, clinical and functional characteristics, neurocognition, neuroimaging, predictors of psychosis development, treatment trials, socioeconomic aspects, nosography, and future challenges in the field. Data Synthesis Relevant articles retrieved in the literature search were discussed by a large group of leading worldwide experts in the field. The core results are presented after consensus and are summarized in illustrative tables and figures. Conclusions The relatively new field of HR research in psychosis is exciting. It has the potential to shed light on the development of major psychotic disorders and to alter their course. It also provides a rationale for service provision to those in need of help who could not previously access it and the possibility of changing trajectories for those with vulnerability to psychotic illnesses.

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Citations
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Journal ArticleDOI

Patients with first-episode, drug-naive schizophrenia and subjects at ultra-high risk of psychosis shared increased cerebellar-default mode network connectivity at rest.

TL;DR: Increased cerebellar-DMN connectivity shared by the UHR subjects and the patients not only highlights the importance of the DMN in the pathophysiology of psychosis but also may be a trait alteration for psychosis.
Journal ArticleDOI

Canadian Treatment Guidelines for Individuals at Clinical High Risk of Psychosis

TL;DR: It was recommended that treatment follow a staged approach with psychological treatments being the first-line treatment and pharmacotherapy reserved for adults, those who did not respond to psychological interventions, and those who had more severe symptoms.
Journal ArticleDOI

The emerging molecular architecture of schizophrenia, polygenic risk scores and the clinical implications for gXe research.

TL;DR: How the paper advances knowledge of polygenic risk scores for use, amongst others, in gene-environment interaction studies and the opportunities and challenges such approaches will bring to the understanding of the epidemiology of psychotic disorders, including schizophrenia are discussed.
Journal ArticleDOI

Prediction of conversion to psychosis in individuals with an at-risk mental state: a brief update on recent developments

TL;DR: In this article, only little more than one-third of individuals classified as being at-risk for psychosis have been shown to actually convert to frank psychosis during follow-up, while there have been enormous efforts to improve the accuracy of predicting this transition.
References
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BookDOI

Reducing risks for mental disorders: Frontiers for preventive intervention research.

TL;DR: This study provides a targeted definition of prevention and a conceptual framework that emphasizes risk reduction and presents a focused research agenda, with recommendations on how to develop effective intervention programs, create a cadre of prevention researchers, and improve coordination among federal agencies.
Journal ArticleDOI

A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder

TL;DR: There is evidence, however, that transitory developmental expression of psychosis (psychosis proneness) may become abnormally persistent and subsequently clinically relevant (impairment), depending on the degree of environmental risk the person is additionally exposed to.
Journal ArticleDOI

Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States

TL;DR: The CAARMS instrument provides a useful platform for monitoring sub threshold psychotic symptoms for worsening into full-threshold psychotic disorder and has good to excellent reliability.
Journal ArticleDOI

Prodromal Assessment With the Structured Interview for Prodromal Syndromes and the Scale of Prodromal Symptoms: Predictive Validity, Interrater Reliability, and Training to Reliability

TL;DR: Data is presented suggesting that excellent interrater reliability can be established for diagnosis in a day-and-a-half-long training workshop and on the Structured Interview for Prodromal Syndromes and the Scale of ProDromal Symptoms.
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