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

Last updated at: 3:15 am, 5th October 2020
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Fact Sheet Technical Commentary
Tags:  High risk of psychosis

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