Early intervention service systems for youth mental health: integrating pluripotentiality, clinical staging, and transdiagnostic lessons from early psychosis

Jai L Shah*, Nev Jones, Jim van Os, Patrick D McGorry, Sinan Gülöksüz

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Challenges associated with operationalising services for the at-risk mental state for psychosis solely in that same diagnostic silo are increasingly well recognised-namely, the differential risk for psychosis being a function of sampling enrichment strategies, declining transition rates to psychosis, questions regarding the validity of transition as an outcome, and the frequent development of non-psychotic disorders. However, recent epidemiological and clinical research suggests that not all threshold-level psychoses are likely to occur homotypically; early-stage non-psychotic syndromes might exhibit heterotypic shifts to a first episode of psychosis, without an identifiable at-risk mental state. These findings, along with the relevance of outcomes beyond traditional diagnoses or syndromes, have substantive implications for developing next-generation early intervention infrastructures. Along with the idea of general at-risk clinics for early-stage pluripotential syndromes, we examine how this reality might affect service design, such as the need for close linkage with centres of expertise for threshold-level disorders when transitions to later stages occur, the balance between generic and specific interventions amid the need for person-centred care, and the challenges this reorientation might pose for broader mental health systems.

Original languageEnglish
Pages (from-to)413-422
Number of pages10
JournalLancet Psychiatry
Volume9
Issue number5
DOIs
Publication statusPublished - May 2022

Keywords

  • ULTRA-HIGH-RISK
  • YOUNG-PEOPLE
  • 1ST-EPISODE PSYCHOSIS
  • HELP-SEEKING
  • 1ST EPISODE
  • CARE
  • INDIVIDUALS
  • DISORDERS
  • MODEL
  • STATE

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