Skip to main content Accessibility help
Hostname: page-component-59b7f5684b-z9m8x Total loading time: 0.558 Render date: 2022-09-27T03:51:30.463Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "displayNetworkTab": true, "displayNetworkMapGraph": false, "useSa": true } hasContentIssue true

EPA guidance on the early detection of clinical high risk states of psychoses

Published online by Cambridge University Press:  16 April 2020

F. Schultze-Lutter
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
C. Michel
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
S.J. Schmidt
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
B.G. Schimmelmann
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
N.P. Maric
School of Medicine, University of Belgrade and Clinic of Psychiatry, Clinical Center of Serbia, Belgrade, Serbia
R.K.R. Salokangas
Department of Psychiatry, University of Turku, Turku, Finland
A. Riecher-Rössler
Center for Gender Research and Early Detection, Psychiatric University Clinics Basel, Basel, Switzerland
M. van der Gaag
Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
M. Nordentoft
Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
A. Raballo
Department of Mental Health, Reggio Emilia Public Health Centre, Reggio Emilia, Italy Regional Working Group on Early Detection of Psychosis, Emilia Romagna Regional Health Service, Bologna, Italy
A. Meneghelli
Dipartimento di Salute Mentale, Centro per l’Individuazione e l’Intervento Precoce nelle Psicosi-Programma 2000, Ospedale Niguarda Ca’ Granda, Milan, Italy
M. Marshall
School of Medicine, University of Manchester, Manchester, UK LANTERN Centre, Lancashire Care NHS Foundation Trust, Preston, UK
A. Morrison
School of Psychological Sciences, University of Manchester, Manchester, UK. Psychosis Research Unit, Greater Manchester West NHS Mental Health Trust, Manchester, UK
S. Ruhrmann
Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
J. Klosterkötter*
Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
*Corresponding author at: Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany. Tel.: +49 221 478 4001; fax: +49 221 478 87139. E-mail (J. Klosterkötter).
Get access


The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion ‘cognitive disturbances’ (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The ‘genetic risk and functional decline’ UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states.

Original article
Copyright © Elsevier Masson SAS 2015

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Addington, JEpstein, ILiu, LFrench, PBoydell, KMZipursky, RB. A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis. Schizophr Res 2011;125(1):5461.CrossRefGoogle ScholarPubMed
Alaghband-Rad, JMcKenna, KGordon, CTAlbus, KEHamburger, SDRumsey, JM, et al.Childhood-onset schizophrenia: the severity of premorbid course. J Am Acad Child Adolesc Psychiatry 1995;34(10):12731283.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV). 4th ed.Washington, DC: American Psychiatric Press; 1994.Google Scholar
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). 5th ed.Washington, DC: American Psychiatric Press; 2013.Google Scholar
Amminger, GPSchäfer, MRPapageorgiou, KKlier, CMCotton, SMHarrigan, SM, et al.Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry 2010;67(2):146154.CrossRefGoogle ScholarPubMed
Ballageer, TMalla, AManchanda, RTakhar, JHaricharan, R. Is adolescent-onset first-episode psychosis different from adult onset?. J Am Acad Child Adolesc Psychiatry 2005;44(8):782789.CrossRefGoogle ScholarPubMed
Bartels-Velthuis, AAvan de Willige, GJenner, JAvan Os, JWiersma, D. Course of auditory vocal hallucinations in childhood: 5-year follow-up study. Br J Psychiatry 2011;199(4):296302.CrossRefGoogle ScholarPubMed
Bechdolf, AThompson, ANelson, BCotton, SSimmons, MBAmminger, GP, et al.Experience of trauma and conversion to psychosis in an ultra-high-risk (prodromal) group. Acta Psychiatr Scand 2010;121(5):377384.CrossRefGoogle Scholar
Bechdolf, AWagner, MRuhrmann, SHarrigan, SPutzfeld, VPukrop, R, et al.Preventing progression to first-episode psychosis in early initial prodromal states. Br J Psychiatry 2012;200(1):2229.CrossRefGoogle ScholarPubMed
Bertolote, JMcGorry, P. Early intervention and recovery for young people with early psychosis: consensus statement. Br J Psychiatry 48(Suppl.)2005 116119.CrossRefGoogle ScholarPubMed
Bodatsch, MRuhrmann, SWagner, MMüller, RSchultze-Lutter, FFrommann, I, et al.Prediction of psychosis by mismatch negativity. Biol Psychiatry 2011;69(10):959966.CrossRefGoogle ScholarPubMed
Buchy, LPerkins, DWoods, SWLiu, LAddington, J. Impact of substance use on conversion to psychosis in youth at clinical high risk of psychosis. Schizophr Res 2014;156(2–3):277280.CrossRefGoogle ScholarPubMed
Campion, JBhui, KBhugra, DEuropean Psychiatric Association European Psychiatric Association (EPA) guidance on prevention of mental disorders. Eur Psychiatry 2012;27(2):6880.CrossRefGoogle ScholarPubMed
Cannon, TDCadenhead, KCornblatt, BWoods, SWAddington, JWalker, E, et al.Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Arch Gen Psychiatry 2008;65(1):2837.CrossRefGoogle ScholarPubMed
Carrión, REMcLaughlin, DGoldberg, TEAuther, AMOlsen, RHOlvet, DM, et al.Prediction of functional outcome in individuals at clinical high risk for psychosis. JAMA Psychiatry 2013;70(11):11331142.CrossRefGoogle ScholarPubMed
Collins, PYPatel, VJoestl, SSMarch, DInsel, TRDaar, AS, et al.Grand challenges in global mental health. Nature 2011;475(7354):2730.CrossRefGoogle ScholarPubMed
Cornblatt, BACarrión, REAddington, JSeidman, LWalker, EFCannon, TD, et al.Risk factors for psychosis: impaired social and role functioning. Schizophr Bull 2012;38(6):12471257.CrossRefGoogle ScholarPubMed
David, CNGreenstein, DClasen, LGochman, PMiller, RTossell, JW, et al.Childhood onset schizophrenia: high rate of visual hallucinations. J Am Acad Child Adolesc Psychiatry 2011;50(7):681686.CrossRefGoogle ScholarPubMed
De Girolamo, GDagani, JPurcell, RCocchi, AMcGorry, PD. Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles. Epidemiol Psychiatr Sci 2012;21(1):4757.CrossRefGoogle ScholarPubMed
Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) Behandlungsleitlinie Schizophrenie. Darmstadt: Steinkopff Verlag; 2006.Google Scholar
Dragt, SNieman, DHVeltman, DBecker, HEvan de Fliert, Rde Haan, L, et al.Environmental factors and social adjustment as predictors of a first psychosis in subjects at ultra high risk. Schizophr Res 2011;125(1):6976.CrossRefGoogle ScholarPubMed
The European Network of Schizophrenia Networks for the Study of Gene-Environment Interactions (EU-GEI) Schizophrenia aetiology: do gene-environment interactions hold the key?. Schizophr Res 2008:102(1–3);2126.CrossRefGoogle Scholar
Fiori Nastro, PSchimmelmann, BGGebhardt, EMonducci, EResch, FKoch, E, et al.[Challenges in the early detection of psychosis in children and adolescents]. Riv Psichiatr 2012;47(2):116125.Google Scholar
Fusar-Poli, PHobson, RRaduelli, MBalottin, UReliability and validity of the comprehensive assessment of the at risk mental state, Italian version (CAARMS-I). Curr Pharm Des 2012;18(4):386391.CrossRefGoogle Scholar
Fusar-Poli, PBorgwardt, SBechdolf, AAddington, JRiecher-Rössler, ASchultze-Lutter, F, et al.The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 2013;70(1):107120.CrossRefGoogle ScholarPubMed
Fusar-Poli, PByrne, MBadger, SValmaggia, LRMcGuire, PKOutreach and support in south London (OASIS), 2001–2011: ten years of early diagnosis and treatment for young individuals at high clinical risk for psychosis. Eur Psychiatry 2013;28(5):315326.CrossRefGoogle ScholarPubMed
Fux, LWalger, PSchimmelmann, BGSchultze-Lutter, FThe schizophrenia proneness instrument, child and youth version (SPI-CY): practicability and discriminative validity. Schizophr Res 2013:146(1–3);6978.CrossRefGoogle ScholarPubMed
Gaebel, WMöller, HJEuropean guidance–a project of the European Psychiatric Association. Eur Psychiatry 2012; 27: 6567.CrossRefGoogle Scholar
Gater, RJordanova, VMaric, NAlikaj, VBajs, MCavic, T, et al.Pathways to psychiatric care in Eastern Europe. Br J Psychiatry 2005; 186: 529535.CrossRefGoogle ScholarPubMed
González-Pinto, ARuiz de Azúa, SIbáñez, BOtero-Cuesta, SCastro-Fornieles, JGraell-Berna, M, et al.Can positive family factors be protective against the development of psychosis?. Psychiatry Res 2011;186(1):2833.CrossRefGoogle Scholar
Gore, FMBloem, PJPatton, GCFerguson, JJoseph, VCoffey, C, et al.Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet 2011;377(9783):20932102.CrossRefGoogle ScholarPubMed
Gross, GHuber, GKlosterkötter, JLinz, MBonner Skala für die Beurteilung von Basisymptomen. BSABS; Bonn Scale for the assessment of basic symptoms Berlin:Springer-Verlag;1987.Google Scholar
Häfner, HRiecher-Rössler, AHambrecht, MMaurer, KMeissner, SSchmidtke, A, et al.IRAOS: an instrument for the assessment of onset and early course of schizophrenia. Schizophr Res 1992;6(3):209223.CrossRefGoogle ScholarPubMed
Häfner, HMaurer, KLöffler, WRiecher-Rössler, A. The influence of age and sex on the onset and early course of schizophrenia. Br J Psychiatry 1993; 162: 8086.CrossRefGoogle ScholarPubMed
Häfner, HMaurer, KLöffler, WFätkenheuer, Ban der Heiden, WRiecher-Rössler, A, et al.The epidemiology of early schizophrenia. Influence of age and gender on onset and early course. Br J Psychiatry 1994;Suppl.(23):2938.CrossRefGoogle ScholarPubMed
Harrison, PJWeinberger, DR. Schizophrenia genes, gene expression and neuropathology on the matter of their convergence. Mol Psychiatry 2005;10(Suppl.3):4068.CrossRefGoogle ScholarPubMed
Hlastala, SAMcClellan, J. Phenomenology and diagnostic stability of youths with atypical psychotic symptoms. J Child Adolesc Psychopharmacol 2005;15(3):497509.CrossRefGoogle ScholarPubMed
Jackson, DKirkbride, JCroudace, TMorgan, CBoydell, JErrazuriz, A, et al.Meta-analytic approaches to determine gender differences in the age-incidence characteristics of schizophrenia and related psychoses. Int J Methods Psychiatr Res 2013;22(1):3645.CrossRefGoogle ScholarPubMed
Jang, JHShin, NYShim, GPark, HYKim, EJang, GE, et al.Longitudinal patterns of social functioning and conversion to psychosis in subjects at ultra-high risk. Aust N Z J Psychiatry 2011;45(9):763770.CrossRefGoogle ScholarPubMed
Katsura, MOhmuro, NObara, CKikuchi, TIto, FMiyakoshi, T, et al.A naturalistic longitudinal study of at-risk mental state with a 2.4-year follow-up at a specialized clinic setting in Japan. Schizophr Res 2014;158(1–3):3238. Scholar
Kay, SRFiszbein, AOpfer, LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13(2):261276.CrossRefGoogle Scholar
Kayser, JTenke, CEKroppmann, CJAlschuler, DMBen-David, SFekri, S, et al.Olfaction in the psychosis prodrome: electrophysiological and behavioral measures of odor detection. Int J Psychophysiol 2013;90(2):190206.CrossRefGoogle ScholarPubMed
Kelleher, IMurtagh, AMolloy, CRoddy, SClarke, MCHarley, M, et al.Identification and characterization of prodromal risk syndromes in young adolescents in the community: a population-based clinical interview study. Schizophr Bull 2012;38(2):239246.CrossRefGoogle ScholarPubMed
Kelleher, IKeeley, HCorcoran, PLynch, FFitzpatrick, CDevlin, N, et al.Clinicopathological significance of psychotic experiences in non-psychotic young people: evidence from four population-based studies. Br J Psychiatry 2012;201(1):2632.CrossRefGoogle ScholarPubMed
Kim, EJang, JHPark, HYShim, GHwang, JYKim, SN, et al.Pharmacotherapy and clinical characteristics of ultra-high-risk for psychosis according to conversion status: a naturalistic observational study.Early Interv Psychiatry 2012;6(1):3037.CrossRefGoogle ScholarPubMed
Kirkbride, JBFearon, PMorgan, CDazzan, PMorgan, KTarrant, J, et al.Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study. Arch Gen Psychiatry 2006;63(3):250258.CrossRefGoogle ScholarPubMed
Kirkbride, JBErrazuriz, ACroudace, TJMorgan, CJackson, DBoydell, J, et al.Incidence of schizophrenia and other psychoses in England, 1950–2009: a systematic review and meta-analyses. PLoS One 2012;7(3):e31660.CrossRefGoogle ScholarPubMed
Kiss, IKelemen, OKéri, S. Decreased peripheral expression of neuregulin 1 in high-risk individuals who later converted to psychosis. Schizophr Res 2012;135(1–3):198199.CrossRefGoogle ScholarPubMed
Kline, ESchiffman, J. Psychosis risk screening: a systematic review. Schizophr Res 2014;158(1–3):1118. ScholarPubMed
Klosterkötter, JHellmich, MSteinmeyer, EMSchultze-Lutter, F. Diagnosing schizophrenia in the initial prodromal phase. Arch Gen Psychiatry 2001;58(2):158164.CrossRefGoogle ScholarPubMed
Klosterkötter, JSchultze-Lutter, FBechdolf, ARuhrmann, S. Prediction and prevention of schizophrenia: what has been achieved and where to go next?. World Psychiatry 2011;10(3):165174.CrossRefGoogle ScholarPubMed
Koike, STakano, YIwashiro, NSatomura, YSuga, MNagai, T, et al.A multimodal approach to investigate biomarkers for psychosis in a clinical setting: the integrative neuroimaging studies in schizophrenia targeting for early intervention and prevention (IN-STEP) project. Schizophr Res 2013;143(1):116124.CrossRefGoogle Scholar
Kotlicka-Antczak, MPawełczyk, TRabe-Jabłońska, JPawełczyk, APORT (Programme of Recognition and Therapy): the first Polish recognition and treatment programme for patients with an at-risk mental state. Early Interv Psychiatry 201410.1111/eip.12146 [Epub ahead of print].Google ScholarPubMed
Koutsouleris, NRiecher-Rössler, AMeisenzahl, EMSmieskova, RStuderus, EKambeitz-Ilankovic, L, et al.Detecting the psychosis prodrome across high-risk populations using neuroanatomical biomarkers. Schizophr Bull 201410.1093/schbul/sbu078 [Epub ahead of print].Google ScholarPubMed
Koutsouleris, NMeisenzahl, EMDavatzikos, CBottlender, RFrodl, TScheuerecker, J, et al.Use of neuroanatomical pattern classification to identify subjects in at-risk mental states of psychosis and predict disease transition. Arch Gen Psychiatry 2009;66(7):700712.CrossRefGoogle ScholarPubMed
Lam, MMHung, SFChen, EY. Transition to psychosis: 6-month follow-up of a Chinese high-risk group in Hong Kong. Aust N Z J Psychiatry 2006;40(5):414420.CrossRefGoogle ScholarPubMed
Lee, JRekhi, GMitter, NBong, YLKraus, MSLam, M, et al.The longitudinal youth at risk study (LYRIKS)–an Asian UHR perspective. Schizophr Res 2013;151(1–3):279283.CrossRefGoogle ScholarPubMed
Lemos-Giráldez, SVallina-Fernández, OFernández-Iglesias, PVallejo-Seco, GFonseca-Pedrero, EPaíno-Piñeiro, M, et al.Symptomatic and functional outcome in youth at ultra-high risk for psychosis: a longitudinal study. Schizophr Res 2009;115(2–3):121129.CrossRefGoogle ScholarPubMed
Lindgren, MManninen, MKalska, HMustonen, ULaajasalo, TMoilanen, K, et al.Predicting psychosis in a general adolescent psychiatric sample. Schizophr Res 2014;158(1–3):16. Scholar
Manninen, MLindgren, MTherman, SHuttunen, MEbeling, HMoilanen, I, et al.Clinical high-risk state does not predict later psychosis in a delinquent adolescent population. Early Interv Psychiatry 2014;8(1):8790.CrossRefGoogle ScholarPubMed
Marshall, MLewis, SLockwood, ADrake, RJones, PCroudace, T. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 2005;62(9):975983.CrossRefGoogle ScholarPubMed
Mason, OStartup, MHalpin, SSchall, UConrad, ACarr, V. Risk factors for transition to first episode psychosis among individuals with ‘at-risk mental states’. Schizophr Res 712–32004 227237.CrossRefGoogle ScholarPubMed
Maurer, KHörrmann, FTrendler, GSchmidt, MHaefner, H. [Identification of psychosis risk by the Early Recognition Inventory (ERIraos) – Description of the schedules and preliminary results on reliability and validity of the checklist]. Nervenheilkunde 2006;25(1):1116.Google Scholar
McGlashan, TWalsh, BWoods, SThe psychosis-risk syndrome. Handbook for diagnosis and follow-up. New York, NY: Oxford University Press;2010.Google Scholar
McGrath, JSaha, SWelham, JEl, SOMacCauley, CChant, D. A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Med 2004;2:13.CrossRefGoogle ScholarPubMed
Meneghelli, AAlpi, ACascio, MTHäfner, HMaurer, KPreti, A, et al.Italian validation of the early recognition inventory for the retrospective assessment of the onset of schizophrenia checklist: reliability, validity and instructions for use. J Psychopathol 2013;19(1–2):19.Google Scholar
Michel, CRuhrmann, SSchimmelmann, BGKlosterkötter, JSchultze-Lutter, FA stratified model for psychosis prediction in clinical practice. Schizophr Bull 40(6):1533–42, doi:10.1093/schbul/sbu025.CrossRefGoogle Scholar
Michel, CSchultze-Lutter, FSchimmelmann, BG. Screening instruments in child and adolescent psychiatry: general and methodological considerations. Eur Child Adolesc Psychiatry 23(9):725–7, doi:10.1007/s00787-014-0608-x.CrossRefGoogle Scholar
Morrison, APFrench, PWalford, LLewis, SWKilcommons, AGreen, J, et al.Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. Br J Psychiatry 2004; 185: 291297.CrossRefGoogle ScholarPubMed
Morrison, APFrench, PParker, SRoberts, MStevens, HBentall, RP, et al.Three-year follow-up of a randomized controlled trial of cognitive therapy for the prevention of psychosis in people at ultrahigh risk. Schizophr Bull 2007;33(3):682687.CrossRefGoogle ScholarPubMed
Morrison, APStewart, SLFrench, PBentall, RPBirchwood, MByrne, R, et al.Early detection and intervention evaluation for people at high-risk of psychosis-2 (EDIE-2): trial rationale, design and baseline characteristics. Early Interv Psychiatry 2011;5(1):2432.CrossRefGoogle ScholarPubMed
Morrison, APFrench, PStewart, SLBirchwood, MFowler, DGumley, AI, et al.Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial. BMJ 2012;344:e2233.CrossRefGoogle ScholarPubMed
Mrazek, PJHaggerty, HJReducing risks for mental disorders: frontiers for preventive research. Washington, DC: Academy Press; 2013.Google Scholar
National Institute for Health, Clinical Excellence (NICE), Psychosis with coexisting substance misuse: assessment and management in adults and young people. [Online] 2011 [Available at: (Accessed: 25 August 2014)].Google Scholar
National Institute for Health, Clinical Excellence (NICE), Psychosis and schizophrenia in children and young people: recognition and management. [Online] 2013 [Available at: (Accessed: 25 August 2014)].Google Scholar
National Institute for Health, Clinical Excellence (NICE), Psychosis and schizophrenia in adults: treatment and management. [Online] 2014 [Available at: (Accessed: 25 August 2014)].Google Scholar
Nelson, BYuen, KYung, AR. Ultra high risk (UHR) for psychosis criteria: are there different levels of risk for transition to psychosis?. Schizophr Res 2011;125(1):6268.CrossRefGoogle ScholarPubMed
Nelson, BThompson, AYung, AR. Basic self-disturbance predicts psychosis onset in the ultra high risk for psychosis “prodromal” population. Schizophr Bull 2012;38(6):12771287.CrossRefGoogle ScholarPubMed
Nelson, BYuen, HPWood, SJLin, ASpiliotacopoulos, DBruxner, A, et al.Long-term follow-up of a group at ultra high risk (“prodromal”) for psychosis: the PACE 400 study. JAMA Psychiatry 2013;70(8):793802.CrossRefGoogle ScholarPubMed
Nieman, DHRuhrmann, SDragt, SSoen, Fvan Tricht, MJKoelman, JH, et al. Psychosis prediction: stratification of risk estimation with information-processing and premorbid functioning variables. Schizophr Bull 40(6):1482–90, doi:10.1093/schbul/sbt145.CrossRefGoogle Scholar
Olesen, JGustavsson, ASvensson, MWittchen, HUJönsson, B CDBE2010 study group, et al.The economic cost of brain disorders in Europe. Eur J Neurol 2012;19(1):155162.CrossRefGoogle ScholarPubMed
Overall, JEGorham, DR. The brief psychiatric rating scale. Psychol Rep 1962; 10: 799812.CrossRefGoogle Scholar
Perälä, JSuvisaari, JSaarni, SI, et al.Lifetime prevalence of psychotic and bipolar I disorders in a general population. Arch Gen Psychiatry 2007;64(1):1928.CrossRefGoogle Scholar
Phillips, LJYung, ARMcGorry, PD. Identification of young people at risk of psychosis: validation of Personal Assessment and Crisis Evaluation Clinic intake criteria. Aust N Z J Psychiatry 34(Suppl.):2000 164169.CrossRefGoogle ScholarPubMed
Raballo, AMeneghelli, ACocchi, ASisti, DRocchi, MBAlpi, A, et al.Shades of vulnerability: latent structures of clinical caseness in prodromal and early phases of schizophrenia. Eur Arch Psychiatry Clin Neurosci 2014;264(2):155169.CrossRefGoogle ScholarPubMed
Riecher-Rössler, AAston, JVentura, JMerlo, MBorgwardt, SGschwandtner, U, et al.[The Basel Screening Instrument for Psychosis (BSIP): development, structure, reliability and validity]. Fortschr Neurol Psychiatr 2008;76(4):207216.CrossRefGoogle Scholar
Riecher-Rössler, APflueger, MOAston, JBorgwardt, SJBrewer, WJGschwandtner, U, et al.Efficacy of using cognitive status in predicting psychosis: a 7-year follow-up. Biol Psychiatry 2009;66(11):10231030.CrossRefGoogle ScholarPubMed
Ross, RGHeinlein, STregellas, H. High rates of comorbidity are found in childhood-onset schizophrenia. Schizophr Res 2006;88(1–3):9095.CrossRefGoogle ScholarPubMed
Rössler, WSalize, HJvan Os, JRiecher-Rössler, A. Size of burden of schizophrenia and psychotic disorders. Eur Neuropsychopharmacol 2005;15(4):399409.CrossRefGoogle ScholarPubMed
Rubio, JMSanjuán, JFlórez-Salamanca, LCuesta, MJ. Examining the course of hallucinatory experiences in children and adolescents: a systematic review. Schizophr Res 2012;138(2–3):248254.CrossRefGoogle ScholarPubMed
Ruhrmann, SBechdolf, AKühn, KUWagner, MSchultze-Lutter, FJanssen, B, et al.Acute effects of treatment for prodromal symptoms for people putatively in a late initial prodromal state of psychosis. Br J Psychiatry 2007;51(Suppl.)8895.CrossRefGoogle Scholar
Ruhrmann, SSchultze-Lutter, FSalokangas, RKHeinimaa, MLinszen, DDingemans, P, et al.Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study. Arch Gen Psychiatry 2010;67(3):241251.CrossRefGoogle Scholar
Salokangas, RKPatterson, PHeinimaa, MSvirskis, TFrom, TVaskelainen, L, et al.Perceived negative attitude of others predicts transition to psychosis in patients at risk of psychosis. Eur Psychiatry 2012;27(4):264266.CrossRefGoogle ScholarPubMed
Schaeffer, JLRoss, RG. Childhood-onset schizophrenia: premorbid and prodromal diagnostic and treatment histories. J Am Acad Child Adolesc Psychiatry 2002;41(5):538545.CrossRefGoogle ScholarPubMed
Schimmelmann, BGSchultze-Lutter, F. Early detection and intervention of psychosis in children and adolescents: urgent need for studies. Eur Child Adolesc Psychiatry 2012;21(5):239241.CrossRefGoogle ScholarPubMed
Schimmelmann, BGConus, PCotton, SMcGorry, PDLambert, M. Pre-treatment, baseline, and outcome differences between early-onset and adult-onset psychosis in an epidemiological cohort of 636 first-episode patients. Schizophr Res 2007;95(1–3):18.CrossRefGoogle Scholar
Schimmelmann, BGHuber, CGLambert, MCotton, SMcGorry, PDConus, P. Impact of duration of untreated psychosis on pre-treatment, baseline, and outcome characteristics in an epidemiological first-episode psychosis cohort. J Psychiatr Res 2008;42(12):982990.CrossRefGoogle Scholar
Schimmelmann, BGSchmidt, SJCarbon, MCorrell, CU. Treatment of adolescents with early-onset schizophrenia spectrum disorders: in search of a rational, evidence-informed approach. Curr Opin Psychiatry 2013;26(2):219230.CrossRefGoogle ScholarPubMed
Schimmelmann, BGWalger, PSchultze-Lutter, F. The significance of at-risk symptoms for psychosis in children and adolescents. Can J Psychiatry 2013;58(1):3240.CrossRefGoogle ScholarPubMed
Schlosser, DAJacobson, SChen, QSugar, CANiendam, TALi, G, et al.Recovery from an at-risk state: clinical and functional outcomes of putatively prodromal youth who do not develop psychosis. Schizophr Bull 2012;38(6):12251233.CrossRefGoogle Scholar
Schmidt, SJGrunert, VMSchimmelmann, BGSchultze-Lutter, FMichel, C. Differences in coping, self-efficacy, and external control beliefs between patients at-risk for psychosis and patients with first-episode psychosis. Psychiatry Res 2014;219(1):95102.CrossRefGoogle ScholarPubMed
Schultze-Lutter, F. Subjective symptoms of schizophrenia in research and the clinic: the basic symptom concept. Schizophr Bull 2009;35(1):58.CrossRefGoogle ScholarPubMed
Schultze-Lutter, FRuhrmann, SKlosterkötter, JJohannessen, JOMartindale, BCullberg, J, Evolving psychosis. Different stages, different treatments. London, New York: Routledge; 2006 104123.Google Scholar
Schultze-Lutter, FAddington, JRuhrmann, SKlosterkötter, JSchizophrenia proneness instrument adult version (SPI-A). Rome: Giovanni Fioriti Editore s.r.l; 2007.Google Scholar
Schultze-Lutter, FKlosterkötter, JPicker, HSteinmeyer, EMRuhrmann, S. Predicting first-episode psychosis by basic symptom criteria. Clin Neuropsychiatry 2007;4(1):1122.Google Scholar
Schultze-Lutter, FRuhrmann, SBerning, JMaier, WKlosterkötter, J. Basic symptoms and ultrahigh risk criteria: symptom development in the initial prodromal state. Schizophr Bull 2010;36(1):182191.CrossRefGoogle ScholarPubMed
Schultze-Lutter, FResch, FKoch, ESchimmelmann, BG. Früherkennung von Psychosen bei Kindern und Adoleszenten – sind entwicklungsbezogene Besonderheiten ausreichend berücksichtigt ?. Z Kinder Jugendpsychiatr Psychother 2011;39(5):301311.CrossRefGoogle Scholar
Schultze-Lutter, FRuhrmann, SFusar-Poli, PBechdolf, ASchimmelmann, BGKlosterkötter, J. Basic symptoms and the prediction of first-episode psychosis. Curr Pharm Des 2012;18(4):351357.CrossRefGoogle ScholarPubMed
Schultze-Lutter, FMarshall, MKoch, ESchizophrenia proneness instrument, child and youth version; extended English translation (SPI-CY EET). Rome: Giovanni Fioriti Editore s.r.l; 2012.Google Scholar
Schultze-Lutter, FSchimmelmann, BGRuhrmann, SMichel, C. ‘A rose is a rose is a rose’, but at-risk criteria differ. Psychopathology 2013;46(2):7587.CrossRefGoogle Scholar
Schultze-Lutter, FMichel, CSchimmelmann, BG. Prevalence of at-risk criteria of psychosis in children and adolescents, and in young adults: results from two Swiss community samples. Schizophr Res 2014;153(Suppl. 1):134[Abstract].Google Scholar
Schultze-Lutter, FKlosterkötter, JRuhrmann, S. Improving the clinical prediction of psychosis by combining ultra-high risk criteria and cognitive basic symptoms. Schizophr Res 2014; 154(1–3):100106.CrossRefGoogle ScholarPubMed
Simon, AEGrädel, MCattapan-Ludewig, KGruber, KBallinari, PRoth, B, et al.Cognitive functioning in at-risk mental states for psychosis and 2-year clinical outcome. Schizophr Res 2012;142(1–3):108115.CrossRefGoogle ScholarPubMed
Thorup, AWaltoft, BLPedersen, CBMortensen, PBNordentoft, M. Young males have a higher risk of developing schizophrenia: a Danish register study. Psychol Med 2007;37(4):479484.CrossRefGoogle ScholarPubMed
Tolbert, HA. Psychoses in children and adolescents: a review. J Clin Psychiatry 1996;57(Suppl. 3):48. [discussion 46–7].Google ScholarPubMed
van der Gaag, MNieman, DHRietdijk, JDragt, SIsing, HKKlaassen, RM, et al.Cognitive behavioral therapy for subjects at ultrahigh risk for developing psychosis: a randomized controlled clinical trial. Schizophr Bull 2012;38(6):11801188.CrossRefGoogle ScholarPubMed
van Os, JKapur, S. Schizophrenia. Lancet 2009;374(9690):635645.CrossRefGoogle ScholarPubMed
van Os, JKenis, GRutten, BP. The environment and schizophrenia. Nature 2010;468(7321):203212.CrossRefGoogle Scholar
Velthorst, ENieman, DHBecker, HEvan de Fliert, RDingemans, PMKlaassen, R, et al.Baseline differences in clinical symptomatology between ultra high risk subjects with and without a transition to psychosis. Schizophr Res 2009;109(1–3):6065.CrossRefGoogle ScholarPubMed
Velthorst, EDerks, EMSchothorst, PBecker, HDurston, SZiermans, T, et al.Quantitative and qualitative symptomatic differences in individuals at Ultra-High Risk for psychosis and healthy controls. Psychiatry Res 2013;210(2):432437.CrossRefGoogle ScholarPubMed
Velthorst, ENelson, BWiltink, Sde Haan, LWood, SJLin, A, et al.Transition to first episode psychosis in ultra high risk populations: does baseline functioning hold the key?. Schizophr Res 2013;143(1):132137.CrossRefGoogle ScholarPubMed
Walder, DJMittal, VTrotman, HDMcMillan, ALWalker, EF. Neurocognition and conversion to psychosis in adolescents at high-risk. Schizophr Res 2008;101(1–3):161168.CrossRefGoogle ScholarPubMed
Welsh, PTiffin, PA. The ‘at-risk mental state’ for psychosis in adolescents: clinical presentation, transition and remission. Child Psychiatry Hum Dev 2014;45(1):9098.CrossRefGoogle ScholarPubMed
Whithing, JRutjes, AWDinnes, JReitsma, BJBossuyt, PMKleijnen, J. Development and validation of methods assessing the quality of diagnostic accuracy studies. Health Tech Assess 2004;8(25):1234. [iii].Google Scholar
Wittchen, HUJacobi, FRehm, JGustavsson, ASvensson, MJönsson, B, et al.The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011;21(9):655679.CrossRefGoogle ScholarPubMed
Woodberry, KASeidman, LJGiuliano, AJVerdi, MBCook, WLMcFarlane, WR. Neuropsychological profiles in individuals at clinical high risk for psychosis: relationship to psychosis and intelligence. Schizophr Res 2010;123(2–3):188198.CrossRefGoogle ScholarPubMed
World Health Organization. Prevention of mental disorders: effective interventions and policy options. Geneva: World Health Organization; 2004.Google Scholar
Yung, ARMcGorry, PD. The initial prodrome in psychosis: descriptive and qualitative aspects. Aust N Z J Psychiatry 1996;30(5):587599.CrossRefGoogle ScholarPubMed
Yung, ARPhillips, LJYuen, HPFrancey, SMMcFarlane, CAHallgren, M, et al.Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group. Schizophr Res 2003;60(1):2132.CrossRefGoogle ScholarPubMed
Yung, ARYuen, HPMcGorry, PDPhillips, LJKelly, DDell’Olio, M, et al.Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Aust N Z J Psychiatry 2005;39(11–12):964971.CrossRefGoogle ScholarPubMed
Yung, ARPhillips, LJSimmons, MBWard, JThompson, PFrench, P, et al.CAARMS. Comprehensive assessment at risk mental states. Parkville Victoria: The PACE Clinic, ORYGEN Research Centre, University of Melbourne, Department of Psychiatry; 2006.Google Scholar
Yung, ARStanford, CCosgrave, EKillackey, EPhillips, LNelson, B, et al.Testing the ultra high risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people. Schizophr Res 2006;84(1):5766.CrossRefGoogle Scholar
Yung, ARNelson, BStanford, CSimmons, MBCosgrave, EMKillackey, E, et al.Validation of “prodromal” criteria to detect individuals at ultra high risk of psychosis: 2-year follow-up. Schizophr Res 2008;105(1–3):1017.CrossRefGoogle ScholarPubMed
Zhang, TLi, HWoodberry, KASeidman, LJZheng, LLi, H, et al.Prodromal psychosis detection in a counseling center population in China: an epidemiological and clinical study. Schizophr Res 2014;152(2–3):391399.CrossRefGoogle Scholar
Ziermans, TBSchothorst, PFSprong, Mvan Engeland, HTransition and remission in adolescents at ultra-high risk for psychosis. Schizophr Res 2011;126(1–3):5864.CrossRefGoogle ScholarPubMed
Zimmermann, RGschwandtner, UWilhelm, FHPflueger, MORiecher-Rössler, AFuhr, PEEG spectral power and negative symptoms in at-risk individuals predict transition to psychosis. Schizophr Res 2010;123(2–3):208216.CrossRefGoogle ScholarPubMed
Supplementary material: File

Schultze-Lutter et al. supplementary material

Supplementary materials

Download Schultze-Lutter et al. supplementary material(File)
File 137 KB
Submit a response


No Comments have been published for this article.
Cited by