The Psychosis High-Risk State: A Comprehensive State-of-the-Art Review
Open accessAbstract
CONTEXT: During the past 2 decades, a major transition in the clinical characterization of psychotic disorders has occurred. The construct of a clinical high-risk (HR) state for psychosis has evolved to capture the prepsychotic phase, describing people presenting with potentially prodromal symptoms. The importance of this HR state has been increasingly recognized to such an extent that a new syndrome is being considered as a diagnostic category in the DSM-5. OBJECTIVE: To reframe the HR state in a comprehensive state-of-the-art review on the progress that has been made while also recognizing the challenges that remain. DATA SOURCES: Available HR research of the past 20 years from PubMed, books, meetings, abstracts, and international conferences. STUDY SELECTION AND DATA EXTRACTION: Critical review of HR studies addressing historical development, inclusion criteria, epidemiologic research, transition criteria, outcomes, clinical and functional characteristics, neurocognition, neuroimaging, predictors of psychosis development, treatment trials, socioeconomic aspects, nosography, and future challenges in the field. DATA SYNTHESIS: Relevant articles retrieved in the literature search were discussed by a large group of leading worldwide experts in the field. The core results are presented after consensus and are summarized in illustrative tables and figures. CONCLUSIONS: The relatively new field of HR research in psychosis is exciting. It has the potential to shed light on the development of major psychotic disorders and to alter their course. It also provides a rationale for service provision to those in need of help who could not previously access it and the possibility of changing trajectories for those with vulnerability to psychotic illnesses.
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Interactional data such as sentiment trajectories, frequency of self-referential statements, and thematic narrowing could serve as digital phenotypes of emerging risk, paralleling early warning markers in psychosis prodrome research.
“Interactional data (such as sentiment trajectories, frequency of self-referential statements, and thematic narrowing) could serve as digital phenotypes of emerging risk, paralleling early warning markers in psychosis prodrome research [47].”
From Delusional Experiences Emerging From AI Chatbot Interactions or “AI Psychosis” (2025) · cites this paper as [47]
Among specific types of selective or universal interventions, psychopharmacological treatments are rarely used, whereas psychotherapy or psychoeducation are more frequent.
“Among the specific types of selective or universal interventions, psychopharmacological treatments are rarely used 19 , whereas psychotherapy 20 or psychoeducation 21 are more frequent.”
From Universal and selective interventions to promote good mental health in young people: Systematic review and meta-analysis (2020) · cites this paper as [19]
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References 158 · Cited by 1,483
Research works printed but not linked: 3
- [1]Klosterkötter JGG Huber G Wieneke A Steinmeyer EM Schultze-Lutter F Evaluation of the Bonn Scale for the Assessment of Basic Symptoms: BSABS as an instrument for the assessment of schizophrenia proneness: a review of recent findings Neurol Psychiatry Brain Res 1997 5 137 150
- [19]Mayer-Gross W Die Klinik der Schizophrenie Bunke O Handbuch der Geisteskrankheiten IX Berlin, Germany Springer 1932
- [76]Yung AR Stanford C Cosgrave E Killackey E Phillips L Nelson B McGorry PD Testing the Ultra High Risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people Schizophr Res 2006 84 1 57 66 16630707
- Authors
- Fusar-Poli, P., Borgwardt, S., Bechdolf, A., Addington, J., Riecher-Rössler, A., Schultze-Lutter, F., Keshavan, M., Wood, S., Ruhrmann, S., Seidman, L. J., Valmaggia, L., Cannon, T., Velthorst, E., De Haan, L., Cornblatt, B., Bonoldi, I., Birchwood, M., McGlashan, T., Carpenter, W., McGorry, P., Klosterkötter, J., McGuire, P., & Yung, A.
- Affiliations
- University of Basel (CH)
- The University of Melbourne (AU)
- University of Birmingham (GB)
- Beth Israel Deaconess Medical Center (US)
- King's College London (GB)
- University of California, Los Angeles (US)
- Amsterdam UMC Location University of Amsterdam (NL)
- Yale University (US)
- University of Maryland, Baltimore (US)
- University of Cologne (DE)
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2013-01-01
- Volume
- 70
- Issue
- 1
- Pages
- 107
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC4356506
- OpenAlex
- W2198642455
- Cited by
- 1,483
- References
- 158
- Citations by year
- 2026: 66 · 2025: 100 · 2024: 87 · 2023: 90 · 2022: 73 · 2021: 133 · 2020: 143 · 2019: 146 · 2018: 111 · 2017: 105 · 2016: 119 · 2015: 108 · 2014: 105 · 2013: 81 · 2012: 14
- FWCI
- 13.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- PubMed Central (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- edoc (University of Basel) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Institute of Mental Health (U01MH081984)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- psychosis, prodromal symptoms, DSM-5, transition to psychosis, neurocognitive function, neuroimaging, treatment trials, socioeconomic factors, nosography, functional outcome, psychosis prevention
- MeSH terms
- Humans, Psychotic Disorders, Risk, Consensus
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