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Treatments for high-risk groups

What are high-risk groups?

The primary aims of early intervention are to prevent or delay future transition to psychosis in high-risk individuals with early symptoms, and to reduce symptom severity in individuals following a first episode of psychosis. A key target of early intervention is “indicated prevention”, for individuals at high risk of psychosis who have been identified with detectable signs of possible disorder, but do not meet any diagnostic criteria for disorder.

There are two key approaches for identifying patients with early signs that may suggest an ultra-high risk (UHR) of developing psychosis. The first approach is based on Huber’s Basic Symptoms (BS), which focuses on a detailed way of describing phenomenological (subjective) disturbances in the domains of perception, cognition, language, motor function, will, initiative and level of energy, and stress tolerance. Because the basic symptoms refer only to subtle subjectively experienced abnormalities, they may reflect an earlier phase in the disease process than the second approach, which identifies at-risk mental states as a combination of: a Family History (FH) of psychosis plus non-specific symptoms and recent decline in functioning; recent onset Attenuated Psychotic Symptoms (APS) with decline in functioning; and Brief Limited Intermittent Psychotic Symptoms (BLIPS). Whichever approach is utilised to identify those at UHR, a benefit of early intervention – should a transition to psychosis occur – is that the patient is already established in a treatment regime thus reducing the duration of untreated psychosis, which has been associated with increased illness severity.

What is the evidence on treatments for high-risk groups?

Moderate to high quality evidence shows a medium-sized effect of reduced risk of psychosis for up to one year with any focused treatment for ultra-high risk groups, and a small effect for up to four years. Moderate quality evidence suggests a medium-sized effect of cognitive behavioural therapies, either alone or combined with antipsychotic medication, for delaying transition to psychosis for up to two years. Moderate to low quality evidence suggests some benefit of Needs Focused Intervention plus amisulpride over Needs Focused Intervention alone for improving functioning and reducing symptom severity in the short term, although there may be more weight gain with amisulpride.

Also see the Signs and Symptoms, early detection topic, the Course and Outcomes topic on first-episode psychosis and high-risk groups and duration of untreated psychosis, and the psychosocial treatment for high-risk groups topic.

April 2016

Page last updated: 2:28  7 September 2017

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