title: Lessons learned from the psychosis high-risk state: towards a general staging model of prodromal intervention.
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.
  
  
  METHODS
  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.
authors: Department of Psychosis Studies, Institute of Psychiatry, King's College London and OASIS Team, South London and the Maudsley NHS Foundation Trust, London, UK.
authors: P
authors: P
authors: Fusar-Poli
authors: A R
authors: AR
authors: Yung
authors: P
authors: P
authors: McGorry
authors: J
authors: J
authors: van Os
mesh_terms: D018450:Disease Progression; D061345:Early Medical Intervention / Q000379:methods*; D006801:Humans; D008962:Models, Theoretical; D062706:Prodromal Symptoms; D011618:Psychotic Disorders / Q000628:therapy*; D012306:Risk; D012307:Risk Factors; D012559:Schizophrenia / Q000628:therapy*; D013997:Time Factors