EPA guidance on the early detection of clinical high risk states of psychoses

European Psychiatry, Cambridge University Press (CUP), ISSN 1778-3585

Volume 30, 3, 2015

DOI:10.1016/j.eurpsy.2015.01.010, Dimensions: pub.1018334699, PMID: 25735810,



  1. (1) University of Bern, grid.5734.5
  2. (2) Klinički centar Srbije, grid.418577.8
  3. (3) University of Turku, grid.1374.1
  4. (4) Universitäre Psychiatrische Kliniken Basel, grid.412556.1
  5. (5) EMGO Institute for Health and Care Research, grid.466632.3
  6. (6) Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
  7. (7) University of Copenhagen, grid.5254.6, KU
  8. (8) Department of Mental Health, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
  9. (9) Regional Working Group on Early Detection of Psychosis, Emilia Romagna Regional Health Service, Bologna, Italy
  10. (10) Ospedale Niguarda Ca' Granda, grid.416200.1
  11. (11) Lancashire Care NHS Foundation Trust, grid.439737.d
  12. (12) University of Manchester, grid.5379.8
  13. (13) Psychosis Research Unit, Greater Manchester West NHS Mental Health Trust, Manchester, UK
  14. (14) University of Cologne, grid.6190.e


The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion 'cognitive disturbances' (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The 'genetic risk and functional decline' UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states.

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