Clinical High-Risk for Psychosis Syndromes among Swiss and German Youth and Young Adults: Early Identification and Intervention.

Schulze-Lutter, Frauke; Schnyder, Nina; Michel, Chantal; Schmidt, Stefanie J. (2019). Clinical High-Risk for Psychosis Syndromes among Swiss and German Youth and Young Adults: Early Identification and Intervention. In: Handbook of Attenuated Psychosis Syndrome Across Cultures: International Perspectives on Early Identification and Intervention (pp. 115-142). Springer https://doi.org/10.1007/978-3-030-17336-4_6

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In Germany, clinical considerations of using patients’ self-reported early subtle disturbances for an early detection of developing psychosis before its first episode date back to the early 20th century. These resulted in the formulation of the basic symptom concept that assumes that subtle, self-perceivable but rarely externally perceivable disturbances in mental processes—so-called basic symptoms—are the first psychopathological cor- relate of neurobiological processes underlying the development of psychoses, while attenuated and frank psy- chotic symptoms develop later in the course of the disorder as a result of inadequate coping with basic symp- toms as well as other symptoms and stressors. Thus, both in Germany and Switzerland, systematic research on early detection and intervention in psychosis has mainly considered both basic symptom and ultra-high risk cri- teria. Their combined consideration resulted in the first-ever staging model setting out an early and a late risk stage and, relatedly, a staged intervention model much in line with recent recommendations for intervention in a clinical high risk state by the European Psychiatric Association. Based on a first meta-analysis of single risk cri- teria, the basic symptom criterion Cognitive Disturbances and the symptomatic ultra-high risk criteria were al- ternatively recommended for the detection of a clinical high risk syndrome by the European Psychiatric Asso- ciation. Furthermore, research in Switzerland and Germany has focused on developmental issues and the general population, indicating that an onset-revised Attenuated Psychosis Syndrome might have clinical meaning in the general population, in particular in adults, in whom, however, it is infrequent.

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