Cited by 52Schizophrenia research and treatmentBipolar Disorder and TreatmentPsychopathy, Forensic Psychiatry, Sexual Offending

Ultra-high-risk paradigm: lessons learnt and new directions

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McGorry, Patrick D, Mei, Cristina·2018·Evidence Based Mental Health

Abstract

Within the embryonic early psychosis field in the early 1990s, the conceptualisation and definition of an at-risk or ultra-high-risk (UHR) mental state for psychosis was a breakthrough which transformed the clinical and research landscape in psychiatry. Twenty-five years later, we have a new evidence base that has illuminated the neurobiology of the onset phase of psychotic disorder, delivered Cochrane level 1 evidence showing that the onset of full-threshold sustained psychotic disorder can be at least delayed, and is paving the way to a new generation of transdiagnostic research. Here, we document the contribution of the UHR approach to understanding the underlying mechanisms of psychosis onset as well as the long-term outcomes. Particularly, we highlight that psychosis onset can be delayed in those meeting UHR criteria and that these criteria have a higher valence for subsequent psychotic disorders and some valence for persistent non-psychotic syndromes. Critiques have helped to identify some of the limitations of this paradigm, which are acknowledged. These include evidence that psychotic disorders can emerge more acutely and from other, as yet undefined, precursor states. Rather than defending, or alternatively questioning the value of, the UHR approach, we propose a broader, transdiagnostic staging model that is consistent with the pluripotent and variably comorbid trajectories for mental disorders. This approach moves beyond psychosis to capture a wider range of subthreshold symptoms and full-threshold disorders, thus enhancing prediction for the emergence and progression of a range of mental disorders, as well as providing new avenues for early intervention and prevention.

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Authors
McGorry, P. D., & Mei, C.
Affiliations
The University of Melbourne (AU)
Corresponding author
McGorry, Patrick D
Venue
Evidence Based Mental Health
Publisher
BMJ
Published
2018-10-24
Volume
21
Issue
4
Pages
131-133
ISSN
  • 1362-0347 (ISSN-L)
  • 1468-960X
OpenAlex
W2898193019
Cited by
52
References
36
Citations by year
2026: 2 · 2025: 4 · 2024: 8 · 2023: 2 · 2022: 14 · 2021: 6 · 2020: 11 · 2019: 3 · 2018: 1
FWCI
0.80
Type
journal article
Language
en
Open access
Locations
  • Evidence-Based Mental Health (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
National Health and Medical Research Council
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
Keywords
transition to psychosis, early psychosis, psychosis risk syndromes, subthreshold symptoms, long-term outcomes, early intervention, prevention, comorbidities
MeSH terms
Humans, Psychotic Disorders, Disease Progression, Risk Assessment, Prodromal Symptoms

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