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 language | English |
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Pages (from-to) | 413-422 |
Number of pages | 10 |
Journal | Lancet Psychiatry |
Volume | 9 |
Issue number | 5 |
DOIs | |
Publication status | Published - May 2022 |
Keywords
- ULTRA-HIGH-RISK
- YOUNG-PEOPLE
- 1ST-EPISODE PSYCHOSIS
- HELP-SEEKING
- 1ST EPISODE
- CARE
- INDIVIDUALS
- DISORDERS
- MODEL
- STATE