The Clinical High-Risk State: Beyond the Prevention of Psychosis
Objectives This article aims to contextualize and review interventions for patients with a clinical high-risk (CHR) state for psychosis. Method This review explores the literature on the CHR state and focuses more precisely on the development of its defining criteria, the evolution of CHR patients, the main interventions studied so far, and the clinical services implemented to date. Results The CHR criteria were developed from observations on the prodrome of psychotic disorders to prevent or delay the onset of psychosis. These criteria help defining three distinct groups of patients who seek help because of significant distress and functional impairments. The diagnostic evaluation remains a critical step that represents a challenge for clinicians. A significant proportion of CHR patients will not develop a psychotic disorder. And the course can be unfavorable even if there is no conversion to a psychotic disorder. In order to improve the clinical conditions of CHR patients, several interventions have been developed and studied. They fall into two main categories: psychosocial approaches and pharmacotherapy. Clinical initiatives to assess and provide support to these patients have emerged around the world, including in Switzerland, in France, and in Canada. The implementation and the integration of these services within existing health care system are influenced by several factors, including the organization of health care structures. Knowing that only a small proportion of CHR patients will progress to a psychotic disorder, it is relevant to offer these interventions in non-stigmatizing and youth-friendly places. These services would possibly be distinct from first-episode psychosis programs. Conclusion Interventions for CHR patients go well beyond the prevention of psychosis. They meet legitimate clinical needs. We must think about how to deploy them adequately in the most appropriate places.