The Psychosis High-Risk State: A Comprehensive State-of-the-Art Review
Paolo Fusar-Poli,Stefan Borgwardt,Andreas Bechdolf,Jean Addington,Anita Riecher-Rössler,Frauke Schultze-Lutter,Matcheri S. Keshavan,Stephen J. Wood,Stephan Ruhrmann,Larry J. Seidman,Lucia Valmaggia,Tyrone D. Cannon,Eva Velthorst,Lieuwe de Haan,Barbara A. Cornblatt,Ilaria Bonoldi,Max Birchwood,Thomas H. McGlashan,William T. Carpenter,Patrick D. McGorry,Joachim Klosterkötter,Philip McGuire,Alison R. Yung +22 more
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.read more
Citations
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Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders
Cherrie Galletly,David J. Castle,Frances Dark,Verity Humberstone,Assen Jablensky,Eoin Killackey,Jayashri Kulkarni,Patrick D. McGorry,Olav Nielssen,Nga Tran +9 more
TL;DR: This guideline takes a holistic approach, addressing all aspects of the care of people with schizophrenia and related disorders, not only correct diagnosis and symptom relief but also optimal recovery of social function, and uses a clinical staging model as a framework for recommendations regarding assessment, treatment and ongoing care.
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Cognitive Functioning in Prodromal Psychosis: A Meta-analysis
Paolo Fusar-Poli,Giacomo Deste,Renata Smieskova,Stefano Barlati,Alison R. Yung,Oliver D. Howes,Rolf-Dieter Stieglitz,Antonio Vita,Philip McGuire,Stefan Borgwardt +9 more
TL;DR: The HR state for psychosis is associated with significant and widespread impairments in neurocognitive functioning and social cognition, and subsequent transition to psychosis is particularly associated with deficits in verbal fluency and memory functioning.
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Comorbid Depressive and Anxiety Disorders in 509 Individuals With an At-Risk Mental State: Impact on Psychopathology and Transition to Psychosis
TL;DR: The ARMS patients are characterized by high prevalence of anxiety and depressive disorders in addition to their attenuated psychotic symptoms, which may reflect core emotional dysregulation processes and delusional mood in prodromal psychosis.
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Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology:
TL;DR: These guidelines from the British Association for Psychopharmacology address the scope and targets of pharmacological treatment for schizophrenia, and cover the pharmacological management and treatment of schizophrenia across the various stages of the illness.
Journal ArticleDOI
EPA guidance on the early intervention in clinical high risk states of psychoses.
Frauke Schultze-Lutter,Chantal Michel,Stefanie Julia Schmidt,Benno Karl Edgar Schimmelmann,Nadja P. Maric,Raimo K. R. Salokangas,Anita Riecher-Rössler,M. van der Gaag,Merete Nordentoft,Andrea Raballo,Anna Meneghelli,Max Marshall,Anthony P. Morrison,Stephan Ruhrmann,Joachim Klosterkötter +14 more
TL;DR: In this article, the authors provided evidence-based recommendations on early intervention in clinical high risk (CHR) states of psychosis, assessed according to the EPA guidance on early detection, derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples.
References
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Prediction of psychosis by mismatch negativity.
Mitja Bodatsch,Stephan Ruhrmann,Michael Wagner,Ralf Müller,Frauke Schultze-Lutter,Ingo Frommann,Jürgen Brinkmeyer,Wolfgang Gaebel,Wolfgang Maier,Joachim Klosterkötter,Anke Brockhaus-Dumke +10 more
TL;DR: The findings demonstrate the duration MMN is significantly reduced in at-risk subjects converting to first-episode psychosis compared with nonconverters and may contribute not only to the prediction of conversion but also to a more individualized risk estimation and thus risk-adapted prevention.
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The ABC Schizophrenia Study: a preliminary overview of the results.
H. Häfner,Kurt Maurer,W. Löffler,W. an der Heiden,Povl Munk-Jørgensen,M. Hambrecht,Anita Riecher-Rössler +6 more
TL;DR: In early-onset cases, social course and outcome, studied prospectively over 5 years, was determined by the level of social development at onset through social stagnation, which was not explainable by social variables, such as differences in the male-female societal roles.
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Social functioning in individuals at clinical high risk for psychosis
TL;DR: It is demonstrated that even at the pre-psychotic phase of the illness, these young people are demonstrating significant deficits in social functioning, supporting that social deficits are present long before the onset of psychotic symptoms.
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Striatal Presynaptic Dopamine in Schizophrenia, Part II: Meta-Analysis of [18F/11C]-DOPA PET Studies
TL;DR: The present meta-analysis showed consistently increased striatal DSC in schizophrenia, with a 14% elevation in patients as compared with healthy controls, and sensitivity analysis confirmed robustness of meta-analytic findings.
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Abnormal Frontostriatal Interactions in People With Prodromal Signs of Psychosis: A Multimodal Imaging Study
Paolo Fusar-Poli,Oliver D. Howes,Paul Allen,Matthew R. Broome,Isabel Valli,Marie-Claude Asselin,Paul M. Grasby,Philip McGuire +7 more
TL;DR: In people with prodromal signs of psychosis, there are direct correlations between altered prefrontal cortical function and subcortical dopamine synthesis capacity, consistent with the notion that frontostriatal interactions play a critical role in the pathoetiology of schizophrenia.