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January 2013

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

Author Affiliations

Author Affiliations: Departments of Psychosis Studies (Drs Fusar-Poli, Valmaggia, Bonoldi, and McGuire) and Psychology (Dr Valmaggia), King's College London, London, United Kingdom; OASIS team for prodromal psychosis, NHS SLAM Foundation Trust, London (Drs Fusar-Poli, Valmaggia, Bonoldi, and McGuire); Department of Psychiatry, University of Basel, Basel, Switzerland (Drs Borgwardt and Riecher-Rössler); Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany (Drs Bechdolf, Ruhrmann, and Klosterkötter); Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Dr Addington); University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland (Dr Schultze-Lutter); Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (Drs Keshavan and Seidman); Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Melbourne, Australia (Dr Wood); School of Psychology, University of Birmingham, Birmingham, United Kingdom (Drs Wood and Birchwood); Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston (Dr Seidman); Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (Dr Cannon); Department of Early Psychosis, Academic Medical Center, Amsterdam, the Netherlands (Drs Velthorst and De Haan); Department of Psychiatry Research, The Zucker Hillside Hospital, New York, New York (Dr Cornblatt); Yale University School of Medicine, New Haven, Connecticut (Dr McGlashan); Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Dr Carpenter); and Orygen Youth Health Research Centre, University of Melbourne, Melbourne (Drs McGorry and Yung).

JAMA Psychiatry. 2013;70(1):107-120. doi:10.1001/jamapsychiatry.2013.269

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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