EPA guidance on the early intervention in clinical high risk states of psychoses
Abstract
This guidance paper from the European Psychiatric Association (EPA) aims to provide evidence-based recommendations on early intervention in clinical high risk (CHR) states of psychosis, assessed according to the EPA guidance on early detection. The recommendations were derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. Besides analyses on treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies ( n = 1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions. However, early intervention failed to achieve significantly greater functional improvements because both early intervention and control conditions produced similar positive effects. With regard to the type of intervention, both psychological and pharmacological interventions produced significant effects on conversion rates, but not on functional outcome relative to the control conditions. Early intervention in youth samples was generally less effective than in predominantly adult samples. Seven evidence-based recommendations for early intervention in CHR samples could have been formulated, although more studies are needed to investigate the specificity of treatment effects and potential age effects in order to tailor interventions to the individual treatment needs and risk status.
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Indicated prevention approaches have shown potential to reduce subclinical symptoms or prevent onset of a mental disorder in help-seeking and community samples.
“Indicated prevention approaches have shown the potential to reduce subclinical symptoms or even prevent the onset of a mental disorder in help-seeking and community samples [28–31]”
From Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial (2024) · cites this paper as [30]
NICE guidelines prohibit prophylactic antipsychotic treatment, while EPA guidelines allow its use for severe and progressive symptomatology.
“However, while prophylactic treatment with antipsychotics is altogether prohibited by NICE guidelines 9 , the EPA allows its use in the case of severe and progressive symptomatology 10 .”
From Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis (2018) · cites this paper as [10]
Previous pairwise meta-analyses in this field had methodological limitations, including heterogeneous interventions, non-standard clinical high risk samples, non-randomized trials, pooling of time-dependent outcomes, and poor meta-analytical approaches.
“The other meta-analyses were affected by mistakes 19 or methodological limitations”
From Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis (2018) · cites this paper as [10]
Current international guidelines recommend that clinical high risk for psychosis individuals be primarily offered cognitive behavioural therapy with or without family interventions.
“Current international guidelinessuch as those of the National Institute for Health and Care Excellence (NICE) and the European Psychiatric Association (EPA) -recommend that CHR-P individuals be primarily offered cognitive behavioural therapy (CBT) with or without family interventions 9,10 .”
From Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis (2018) · cites this paper as [10]
Evidence converges on a lack of significant benefit for clinical outcomes other than transition to psychosis, including attenuated symptom severity, functioning, depressive comorbidities, distress and quality of life.
“There is also converging lack of significant benefits on other clinical outcomes besides transition to psychosis, such as attenuated symptom severity 14,15,96 , functioning 10,14,18 , depressive comorbidities 15 , distress 14 , and quality of life 14,15 .”
From Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis (2018) · cites this paper as [10]
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References 233 · Cited by 585
- Authors
- Schmidt, S. J., Schultze-Lutter, F., Schimmelmann, B. G., Maric, N. P., Salokangas, R. K. R., Riecher-Rössler, A., van der Gaag, M., Meneghelli, A., Nordentoft, M., Marshall, M., Morrison, A., Raballo, A., Klosterkötter, J., & Ruhrmann, S.
- Affiliations
- University of Bern (CH)
- University of Turku (FI)
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
- University of Copenhagen (DK)
- University of Manchester (GB)
- Regione Emilia-Romagna (IT)
- University of Cologne (DE)
- Corresponding author
- Klosterkötter, J.
- Venue
- European Psychiatry
- Publisher
- Cambridge University Press (CUP)
- Published
- 2015-03
- Volume
- 30
- Issue
- 3
- Pages
- 388-404
- ISSN
- 0924-9338 (ISSN-L)
- 1778-3585
- OpenAlex
- W2024654275
- Cited by
- 585
- References
- 233
- Citations by year
- 2026: 18 · 2025: 37 · 2024: 51 · 2023: 43 · 2022: 33 · 2021: 63 · 2020: 76 · 2019: 78 · 2018: 64 · 2017: 61 · 2016: 42 · 2015: 18 · 2014: 1
- FWCI
- 50.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- European Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
- edoc (University of Basel) (acceptedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- VU Research Portal (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Lundbeckfonden (R155-2014-1724)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- early intervention, psychosis, clinical high risk for psychosis, transition to psychosis, functional outcome, psychological intervention, pharmacological interventions, early detection, youth, age effects, treatment guidelines
- MeSH terms
- Adolescent, Adult, Humans, Male, Psychiatric Status Rating Scales, Psychotic Disorders, Risk Factors, Schizophrenia, Antipsychotic Agents, Treatment Outcome, Practice Guidelines as Topic, Mood Disorders, Early Diagnosis, Early Medical Intervention
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