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Prodromal Psychosis (At-Risk Mental State) Monitoring

Identification and follow-up of clinical high-risk individuals for psychosis

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Psikiyatri department. Book Appointment →

What is Prodromal Psychosis (At-Risk Mental State) Monitoring?

The clinical high-risk (CHR) state for psychosis is characterized by attenuated psychotic symptoms (APS), brief intermittent psychotic symptoms (BIPS), or genetic risk and deterioration syndrome (GRD), assessed using structured interviews like Comprehensive Assessment of At-Risk Mental States (CAARMS) and Structured Interview for Prodromal Syndromes (SIPS). Approximately 15-30% transition to full psychosis within 2-3 years, while many remit or develop other mental health conditions.

CHR services emphasize cognitive behavioral therapy adapted for psychosis (CBTp), family psychoeducation, support for education and employment, treatment of comorbid mood and anxiety disorders, and avoidance of cannabis and stimulants. Antipsychotic medication is generally reserved for transition to full psychosis, although atypical antipsychotics, omega-3 fatty acids, and N-acetylcysteine have been studied with mixed evidence.

Long-term follow-up is essential as transition risk persists for years, and many individuals develop other mental health needs. Specialized early intervention services with multidisciplinary teams (psychiatry, psychology, social work, peer support) provide developmentally appropriate, low-stigma care during this vulnerable period of late adolescence and young adulthood.

Symptoms

Attenuated positive symptoms (sub-threshold delusions, hallucinations, disorganized thinking)
Unusual thought content
Suspiciousness, paranoia
Perceptual disturbances
Disorganized communication
Brief intermittent psychotic symptoms (less than 7 days, spontaneous remission)
Genetic high risk plus functional decline
Decline in role functioning (school, work, social)
Sleep disturbance
Concentration difficulties
Anxiety, depression
Social withdrawal
Negative symptoms (anhedonia, avolition)
Cognitive deficits (working memory, processing speed)
Suicidal ideation
Self-harm
Substance use (especially cannabis)
Trauma exposure
Family conflict
Identity confusion

Risk Factors

Family history of schizophrenia spectrum disorders
Adolescence and young adulthood (peak 14-25 years)
Cannabis use, especially high-potency THC
Methamphetamine, hallucinogen use
Childhood trauma, abuse, neglect
Migration, minority status
Urban upbringing
Obstetric complications
22q11.2 deletion syndrome
16p13.11 microdeletion
Prader-Willi syndrome
Trisomy 13
Childhood psychiatric conditions
Pre-existing anxiety, depression
ADHD
Attenuated psychotic symptoms above threshold
Functional decline
Genetic high risk plus deterioration
Identical twin with psychosis
Mother with severe perinatal illness

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Subthreshold psychotic symptoms in adolescent or young adult
  • Family history with new symptoms
  • Decline in school, work, social function
  • Brief psychotic episodes
  • Substance-induced psychosis with persisting symptoms
  • 22q11.2 deletion syndrome with new symptoms
  • Youth with cannabis use and unusual thoughts
  • Suicidal ideation in at-risk youth
  • Trauma exposure with mental health symptoms
  • Concerning communications
  • Persistent unusual experiences
  • Pre-emptive screening for high-risk family members

Treatment Methods

01
Comprehensive psychiatric assessment with consideration of CHR criteria
02
Structured interviews: CAARMS, SIPS
03
Functional assessment (Social and Occupational Functioning Assessment Scale, SOFAS)
04
Mental status examination
05
Collateral history from family, school, work
06
Substance use screening (urine toxicology if indicated)
07
Comprehensive medical and neurological evaluation
08
Screening labs (CBC, CMP, TSH, vitamin B12, syphilis, HIV)
09
Brain MRI if focal neurological signs or atypical presentation
10
Cognitive testing
11
Developmental and trauma history
12
Genetic testing in selected cases (22q11.2 deletion)
13
Cognitive behavioral therapy for psychosis (CBTp) — primary intervention
14
Family psychoeducation and behavioral family therapy
15
Education and vocational support
16
Substance use treatment (especially cannabis cessation)
17
Trauma-focused therapy when indicated
18
Treatment of comorbid mood and anxiety disorders with SSRIs
19
Sleep optimization
20
Stress management, mindfulness-based interventions
21
Omega-3 fatty acids (mixed evidence)
22
N-acetylcysteine (investigational)
23
Antipsychotics generally reserved for transition (selected cases for severe attenuated symptoms)
24
Avoid stimulants if possible
25
Multidisciplinary early intervention service
26
Long-term follow-up (at least 2-3 years)
27
Monitor for transition with structured assessments
28
Coordinate with primary care
29
Suicide risk assessment at each visit
30
Patient and family advocacy resources

Which Department to Visit?

You can visit our Psikiyatri department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.