Intervention Strategies for Attenuated Psychosis Syndromes: A Review of Current Practice, Evidence, and Future Directions

Abstract

The rapid surge in research on the prodromal phase of psychosis has been motivated by the promise of early intervention. Earlier treatment in diagnosed psychotic disorders does appear to improve long-term outcomes and intervention in those at risk and shows promise for delaying and possibly even preventing full psychosis. The current chapter discusses the rationale for, models of, and current state of intervention science for specific Psychosis-Risk Syndromes, here collectively referred to under the umbrella term, Attenuated Psychosis Syndromes (APS). The chapter will summarize the findings and quality of intervention studies to date, as well as the emerging guidelines for practitioners. The vast majority of studies have been conducted in Western samples using the Comprehensive Assessment of At-Risk Syndromes (CAARMS), Structured Interview for Psychosis-Risk Syndromes (SIPS), or basic symptom approach (e.g., the Schizophrenia Proneness Instrument for Adults [SPI-A]) to identify APS. Results are promising and emerge from studies of specialized intervention with samples in largely well-educated and well-resourced countries, including preliminary support for the cost-effectiveness of intervention in those at risk in these same settings. However, largely due to small sample sizes, short follow-ups for testing effects on conversion, and small to moderate effects overall, no gold standard intervention stands out above the rest. Most interventions are untested in low-resourced countries, cultures with less medical views of mental illness and mental health care, or in sufficiently large and diverse samples to examine the role of race, ethnicity, culture, education, and economics in treatment preferences, engagement, and response. The effectiveness of more traditional or culturally acceptable care (e.g., traditional healers, at-home care by family, or community engagement) as “treatment as usual” or interventions in-and-of-themselves will be an important comparison for developing and testing early intervention models in new cultural contexts and in both developing and developed countries.