Prevention of Psychosis in the Symptomatic Prodromal Phase
Evidence has been accumulating that it may be possible to achieve prevention in psychotic disorders. Solid evidence has come forward from the TIPS study for tertiary and secondary prevention, providing proof of concept that prevention in psychosis is possible and might be extended to the disorder itself. Direct but preliminary evidence for primary prevention has been generated by clinical trials in Australia, Europe and the US. If we can identify people about to become psychotic with high accuracy, we can track them to understand more about how psychosis unfolds. Appropriate intervention at this stage could also prevent or delay the onset of psychosis and/or subsequent deterioration, i.e., social and instrumental disability, suicide, aggressive behavior, affective- and cognitive deficits. However, there are still major methodologically and practical challenges that need to be solved. The health services need to be able to identify and recruit persons who meet the current criteria which might be difficult because individuals in the high risk group don't necessarily seek guidance actively. Other challenges concern the sensitivity and specificity of the current UHR criteria, which in turn reflects the heterogeneity of a psychosis high-risk state as well as the heterogeneity of the traditional mental disorders.
Discussion
Evidence has been accumulating that it may be possible to achieve prevention in psychotic disorders. Solid evidence has come forward from the TIPS study for tertiary and secondary prevention, providing proof of concept that prevention in psychosis is possible and might be extended to the disorder itself. Direct but preliminary evidence for primary prevention has been generated by clinical trials in Australia, Europe and the US. If we can identify people about to become psychotic with high accuracy, we can track them to understand more about how psychosis unfolds. Appropriate intervention at this stage could also prevent or delay the onset of psychosis and/or subsequent deterioration, i.e., social and instrumental disability, suicide, aggressive behavior, affective- and cognitive deficits. However, there are still major methodologically and practical challenges that need to be solved. The health services need to be able to identify and recruit persons who meet the current criteria which might be difficult because individuals in the high risk group don't necessarily seek guidance actively. Other challenges concern the sensitivity and specificity of the current UHR criteria, which in turn reflects the heterogeneity of a psychosis high-risk state as well as the heterogeneity of the traditional mental disorders.
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