Prediction of psychoses

The worldwide established early detection and prevention centers for psychosis follow the modern program of predictive, preventive and personalized medicine. If primary prevention is to succeed, the individual risk of the disease has to be estimated correctly and the psychosis onset has to be accurately predicted. Accordingly, this article presents the current possibilities for prediction. An overview on the recent prediction analyses in clinical high risk for psychosis research is provided. The previously identified high-risk criteria achieve a considerable predictive power, which can be further enhanced by their combined use as well as other strategies of risk enrichment and risk stratification. Clinical prediction already allows risk-adapted prevention measures and is currently being enhanced even further by additional biological brain diagnostics

Prevention of psychotic disorders

Psychotic disorders set the first example that prediction and prevention programs of modern medicine can also be successfully applied to central psychiatric disorders. In the last 20 years criteria for the detection of high-risk states prior to the first onset of the disease have been worked out and the predictive power for the transition into psychosis has been confirmed. In the centers for early recognition and prevention, persons seeking help and advice can now be classified into individuals in an early or late high-risk stage by means of newly developed instruments. New possibilities of risk stratification ensure a more individualized selection of appropriate preventive measures. The interventions provided aim at improving risk symptoms, preventing psychosocial disabilities and in particular preventing or at least delaying the onset of psychosis. Proof of efficacy is so far available for newly developed psychotherapeutic methods, neuroprotective agents and low dosage antipsychotics. Prior to administration careful risk-benefit analyses have to be carried out for each individual case

Check-ups and screening for young people. What is reasonable with respect to psychiatric disorders?

Severe mental illnesses become manifested early in life. First episodes are suffered in young adulthood at the latest and early symptoms and signs are often already reported in childhood and adolescence. Therefore, it is exactly these adolescents and young adults who have to be reached to detect signs early. In this article the check-ups and screening procedures routinely offered for this target group as well as the role of groups of persons who accompany young people in a variety of contexts are illustrated. Potential extensions with elements and structures for the early recognition of severe mental illnesses are outlined. With the integration of psychiatric peculiarities and drug consumption into the diagnostic battery of the first adolescence healthcare examination (Jugendgesundheitsuntersuchung J1), the often already established familiarity of young persons and the waiving of costs by the health insurances, the J1 seems to be well-suited to provide a rough screening for precursor stages and risk factors for the development of severe mental illnesses and for the detection of a suspected manifest mental disorder. The primary role of most persons working with young people is to be a contact partner and to help transferring the person to the adequate service. Several early recognition centers were founded in Germany to offer low-threshold contact services in the view of existing barriers to care for help-seeking young persons and to provide the complex diagnostics. The adolescence healthcare examinations can be a useful element for early detection of mental disorders and damaging behavior if the utilization rate is high and actions taken in case of suspected beginning disorder/damaging behavior are evaluated. To date, screening instruments for psychiatric disorders should not be used in wide population classes without group-specific targets and without direct contact between therapists and patients. Already established preventive services and initiatives should be interlinked. The health effects of the actions have to be analyzed