Attenuated Psychosis Syndrome

Abstract

Introduction: In the past two decades, there have been a number of studies that test preventive intervention strategies for young people at imminent and elevated clinical risk for psychosis. We review these studies, integrate their findings, and lay out a framework for future clinical trials. Methods: We used keywords relevant to risk for psychosis and schizophrenia to search in PubMed for randomized clinical trials (RCTs) in clinical or ultra-high-risk (CHR/UHR) cohorts, reviewing references to find earlier studies cited, and PubMed to identify later studies that referenced them. Studies are described with respect to interventions tested and treatment outcomes. Results: For RCTs in CHR/UHR cohorts, interventions have included pharmacological strategies, such as second-generation antipsychotics (SGA), omega-3 polyunsaturated fatty acids (PUFA), lithium, and modulators of N-methyl-D-aspartate-type (NMDA) receptors; psychological strategies of cognitive behavioral therapy (CBT), family therapy, and cognitive remediation (CR); and combinations of these. Outcome measures include psychosis onset, clinical symptoms, function, and cognition. Discussion: Overall, among pharmacological strategies, only omega-3 polyunsaturated fatty acids showed efficacy in preventing psychosis onset in initial study, whereas second-generation antipsychotics have led to significant side effects and high dropout. Meta-analysis shows that cognitive behavioral therapy holds promise as a treatment, but it remains unclear to what extent this reflects nonspecific effects of clinician contact. In initial studies, cognitive remediation is effective for improving cognitive deficits such as in processing speed, with concurrent improvement in function. Many promising strategies await study, including exercise and neurostimulation.