Intervention in Clinical High Risk States - Current Status and Future Perspectives

Abstract

Introduction

During the last twenty years, international efforts advanced the prevention of psychosis considerably. However, improved predictions as well as well-tolerated and needs-tailored interventions are still required.

Objectives

Prediction and Prevention of Psychosis

Aims Presenting the current state and new developments, including the European Union funded multi-center project PRONIA with regard to prediction (www.pronia.eu, 7^th Framework Programme grant agreement n° 602152) and the German multi-center trial ESPRIT funded by the Federal Ministry of Education and Research (BMBF grants 01EE1407 C and 01EE1407I) with regard to prevention.

Methods

Results of meta-analyses will be presented and discussed with regard to achievements and challenges. Possible advances by current projects will be discussed.

Results

Pharmacological as well as psychological prevention has been shown to reduce the incidence rate of psychosis in the respective samples considerably. However, particularly social and role functioning, which are prognostically most important, are still an unsolved challenge. Furthermore, new interventions providing an improved tolerability and acceptance by the patients are required. On the level of prediction, a further improvement of predictive validity, particularly with regard to individualized risk estimation is desired.

Conclusions

The achievements in the field of prevention of psychosis are impressive, but further progress is needed. This should be achieved by studies like PRONIA, which aims at improving risk estimation by an advanced assessment concept as well as a sophisticated data analysis, and ESPRIT, which compares the effects of N-Acetylcysteine with an innovative, modular psychological prevention program focusing not only stress and symptom management, but also social cognitive domains.

Disclosure of interest

Consultant to Boehringer Ingelheim lecture fees by Boehringer Ingelheim, Otsuka travel grant by Servier.