© 2003 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
The "Close-in" or Ultra High-Risk Model: A Safe and Effective Strategy for Research and Clinical Intervention in Prepsychotic Mental Disorder
ORYGEN Youth Health and ORYGEN Research Centre (incorporating EPPIC and PACE) Parkville, Victoria, Australia
ORYGEN Research Centre (incorporating EPPIC and PACE) Parkville, Victoria, Australia
Send reprint requests to Patrick D. McGorry, M.D., Ph.D., ORYGEN Research Centre, Locked Bag 10, Parkville, Australia 3052; e-mail: mcgorry{at}ariel.unimelb.edu.au
The development of a new frontier for research and early intervention in psychotic disorders is highly dependent on the construction of synergistic clinical infrastructures. This has catalyzed great progress in the recognition, enhanced treatment, and study of first episode psychosis, and the task is even more challenging when the boundaries are extended to include the earliest clinical phase of illness, the prodromal or prepsychotic phase. This article describes the conceptual and practical building blocks for the construction of service models for intervention in the postonset clinical phase prior to the attainment of current diagnostic thresholds. This is best regarded as indicated prevention, a form of very early secondary prevention, which involves a blend of immediate clinical care combined with research-oriented preventive intervention. The experience of the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne across several stages of growth is described and contrasted with that of several emerging centers in Europe and North America. The progress to date, the lessons learned, and the unresolved challenges and opportunities are detailed. It is concluded that service models can be developed that are acceptable and helpful to young people and their families, and that create a unique environment for the study of the transition to frank psychotic disorder. The ultimate clinical utility and general safety of this approach and the range of effective treatments remain unclear, and will be determined by more extensive research. Such research must be conducted in a logical and rigorous manner with the best designs possible, sensitive to input from consumers and caregivers and to ethical considerations.
Keywords: psychosis / Prodrome / high risk / prevention
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. Savitz, L. van der Merwe, D. J. Stein, M. Solms, and R. Ramesar Neuropsychological status of bipolar I disorder: impact of psychosis The British Journal of Psychiatry, March 1, 2009; 194(3): 243 - 251. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Nelson, A. R. Yung, A. Bechdolf, and P. D. McGorry The Phenomenological Critique and Self-disturbance: Implications for Ultra-High Risk ("Prodrome") Research Schizophr Bull, March 1, 2008; 34(2): 381 - 392. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. D. McGorry, A. R. Yung, A. Bechdolf, and P. Amminger Back to the Future: Predicting and Reshaping the Course of Psychotic Disorder Arch Gen Psychiatry, January 1, 2008; 65(1): 25 - 27. [Full Text] [PDF]
|
|
|
|
|
|
T. D. Cannon, K. Cadenhead, B. Cornblatt, S. W. Woods, J. Addington, E. Walker, L. J. Seidman, D. Perkins, M. Tsuang, T. McGlashan, et al. Prediction of Psychosis in Youth at High Clinical Risk: A Multisite Longitudinal Study in North America Arch Gen Psychiatry, January 1, 2008; 65(1): 28 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. H. McGlashan, J. Addington, T. Cannon, M. Heinimaa, P. McGorry, M. O'Brien, D. Penn, D. Perkins, R. K. R. Salokangas, B. Walsh, et al. Recruitment and Treatment Practices for Help-Seeking "Prodromal" Patients Schizophr Bull, May 4, 2007; (2007) sbm025v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. R. Yung, H. P. Yuen, G. Berger, S. Francey, T.-C. Hung, B. Nelson, L. Phillips, and P. McGorry Declining Transition Rate in Ultra High Risk (Prodromal) Services: Dilution or Reduction of Risk? Schizophr Bull, May 1, 2007; 33(3): 673 - 681. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Seidman, A. J. Giuliano, C. W. Smith, W. S. Stone, S. J. Glatt, E. Meyer, S. V. Faraone, M. T. Tsuang, and B. Cornblatt Neuropsychological Functioning in Adolescents and Young Adults at Genetic Risk for Schizophrenia and Affective Psychoses: Results from the Harvard and Hillside Adolescent High Risk Studies Schizophr Bull, July 1, 2006; 32(3): 507 - 524. [Abstract] [Full Text] [PDF]
|
|