Treatments for high-risk groups

This topic includes both pharmaceutical and psychosocial treatments.
What are high-risk groups?
A key target of early intervention is “indicated prevention” for individuals at high risk of psychosis who have been identified with early signs of the disorder, but do not meet any diagnostic criteria. There are two key approaches for identifying people with early signs. The first approach is based on Huber’s Basic Symptoms, 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. The second approach identifies at-risk mental states as a combination of a family history of psychosis plus non-specific symptoms and recent decline in functioning, recent onset attenuated psychotic symptoms with a decline in functioning, and brief, limited, intermittent psychotic symptoms.
Early intervention treatments for people identified at a high risk of psychosis often comprise both pharmaceutical and psychosocial therapies, consequently this table presents the evidence for both.
What is the evidence for treatments for high-risk groups?
Moderate quality evidence suggests cognitive behavioural therapy (CBT) may reduce the risk of transition to psychosis for up to two years when compared to monitoring or supportive therapy, with no differences between these interventions in symptoms, functioning, study retention or quality of life. There were some advantages of ziprasidone plus needs-based interventions for improving attenuated psychotic symptoms when compared to needs-based interventions alone, CBT plus needs-based interventions, or risperidone plus CBT and needs-based interventions.
There were no differences in rates of transitioning to psychosis between needs-based interventions with versus without additional components (aripiprazole, olanzapine, ziprasidone, risperidone, glycine or D-serine, omega-3, CBT, integrated therapies, or family therapies). There were no differences between CBT, omega-3, or cognitive remediation and various control conditions for social functioning, and no differences between NMDAR (glutamate) modulators, CBT, omega-3, risperidone, family therapies, or cognitive remediation and control conditions for negative symptoms.
September 2020
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Risk factors and antecedents
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Non-genetic risk factors
- Adult life events
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- Smoking
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- Suicide and self-harm
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Pharmaceutical
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First-generation antipsychotics
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Side effects
- Blood disorders
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Second-generation antipsychotics
- All antipsychotics versus placebo
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Side effects
- Blood disorders
- Bone density
- Cancer
- Cardiometabolic changes and weight gain
- Catatonia
- Constipation
- Dysphagia
- Extrapyramidal
- Hyperprolactinaemia
- Hypersalivation
- Hypomania
- Hyponatraemia
- Mortality
- Neuroleptic malignant syndrome
- Neutropenia
- Oculogyric crisis
- Pancreatitis
- Polycystic ovarian syndrome
- Sedation
- Seizures
- Sexual dysfunction
- Thyroid dysfunction
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Adjunctive treatments
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- Estrogen
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- Herbal medicines
- Mood stabilisers
- Oxytocin
- Promethazine
- Serotonin modulators
- Sodium nitroprusside
- Statins
- Testosterone
- Alternative treatments
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Treatments for specific symptoms and populations
- Treatments during pregnancy and breastfeeding
- Treatments for aggression and agitation
- Treatments for childhood and early-onset schizophrenia
- Treatments for cognitive symptoms
- Treatments for constipation
- Treatments for depressive symptoms
- Treatments for dual diagnosis
- Treatments for elderly people and people with late-onset schizophrenia
- Treatments for first-episode psychosis
- Treatments for high-risk groups
- Treatments for hyperprolactinaemia
- Treatments for hypersalivation
- Treatments for medication non-adherence
- Treatments for medication-resistant schizophrenia
- Treatments for movement disorders
- Treatments for negative symptoms
- Treatments for relapse prevention
- Treatments for schizoaffective disorder
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Therapies
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- Day centres and day hospitals
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- Distraction techniques
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- Enriched intervention
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Therapies for specific symptoms and populations
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- Therapies for treatment non-adherence
- Therapies for treatment resistance
- Therapies for unemployment
- Therapies for weight gain
- Treatments for high-risk groups
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Therapies
-
Physical
-
Risk factors and antecedents
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Antecedents
- Attention dysfunction
- Autonomic nervous system anomalies
- Behavioural disturbances and psychopathology
- Dermatoglyphic anomalies
- Eye tracking anomalies
- Face emotion processing anomalies
- Height and body mass index
- IQ and academic performance
- Mild physical anomalies
- Motor dysfunction
- Olfactory identification deficits
- Sleep disturbance
- Speech and hearing deficits
- Stress responsivity anomalies
-
Non-genetic risk factors
- Adult life events
- Childhood adversity
- Congenital rubella syndrome
- Environmental toxins
- Ethnicity
- Family relationships
- Famine
- Genetic and non-genetic risk
- Infectious agents
- Latitude, climate and winter birth
- Marital status
- Maternal diet and body mass index
- Maternal illness during pregnancy
- Migration
- Obstetric complications
- Parental age at birth
- Parental education
- Parental psychological factors
- Sex differences
- Sibship
- Social capital
- Socioeconomic status
- Substance use
- Traumatic brain injury
- Urban environment
- Genetic risk factors
-
Antecedents
-
Illness course and outcomes
- Absconding
- Age at onset
- Childhood and early-onset schizophrenia
- Creativity
- Criminal offending, aggression and violence
- Criminal victimisation
- Cultural differences
- Diet
- Drug and alcohol use
- Duration of untreated psychosis
- Duration of untreated psychosis and outcomes
- Electronic device use
- Employment
- First-episode psychosis
- Functional outcomes
- Homelessness
- Hope
- Late-onset schizophrenia
- Loneliness
- Mortality
- Parenthood
- Pathways to care
- Physical activity
- Physical health monitoring
- Psychotic relapse
- Quality of care
- Quality of life
- Relationships
- Religiosity
- Remission and recovery
- Sex differences
- Smoking
- Stigma and attitudes towards mental health
- Suicide and self-harm
- Treatment adherence
- Treatment-resistance
- Insights for families
-
Physical features
-
Functional changes
- Body functioning
-
Biochemical changes
- Brain pH and lactate
- cAMP
- Cholesterol
- Dopamine
- Endocannabinoids
- GABA
- Hormonal changes
- Hypothalamic-pituitary-adrenal axis
- Infectious agents
- Inflammation and the immune system
- Lipids
- Melatonin
- Melatonin
- Neurometabolites
- Neuropeptides
- Neurotrophins
- Nitric oxide
- NMDA receptor function
- Oxidative stress
- S100 Proteins
- Serotonin
- Synaptic proteins
- Trace elements
- Vascular endothelial growth factor
- Vitamin B
- Vitamin D
- Cerebral blood flow and metabolism
- Electrophysiology
- Structural changes
- Brain regions
-
Functional changes
-
Co-occurring conditions
- Mental disorders
-
Physical disorders
- Auditory system dysfunction
- Autoimmune diseases
- Blood disorders
- Cancer
- Cerebrovascular disease
- Dementia
- Dental disease
- Diabetes
- Digestive disorders
- Epilepsy
- Heart disease
- Infectious diseases
- Metabolic syndrome
- Musculoskeletal and connective tissues
- Obesity
- Peripheral vascular disease
- Polycistic ovary syndrome
- Postoperative complications
- Reproductive and urological disorders
- Respiratory system dysfunction
- Sexual dysfunction
- Skin disorders
- Sleep apnea
- Thyroid disorders
- Underweight
- Visual impairment
- Substance use
- Epidemiology
- General information
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Podcast Library
Green - Topic summary is available.
Orange - Topic summary is being compiled.
Red - Topic summary has no current systematic review available.