Canadian Treatment Guidelines for Individuals at Clinical High Risk of Psychosis

Abstract

Objective: Young people who are at clinical high risk (CHR) of developing psychosis are often help seeking and have significant distress and dysfunction. There are limited guidelines for the assessment and treatment for this population. The aim of this guideline was to develop treatment recommendations for this at-risk group.Method: A systematic search was conducted for published guidelines for CHR. All current guidelines for schizophrenia were reviewed for treatment guidelines on individuals at CHR. The recommendations adopted were primarily drawn from the European Psychiatric Association (EPA) guidance on the early intervention in clinical high-risk states of psychoses and the 2014 National Institute for Health and Care Excellence (NICE) guidelines on the treatment and management of those at CHR for psychosis.Results: After the guideline development process described, 9 recommendations were developed based on the quality of evidence, appropriateness for the Canadian health care system, and clinical expert consensus.Conclusions: Assessment by an expert in the field was the first recommendation. It was recommended that treatment follow a staged approach with psychological treatments being the first-line treatment and pharmacotherapy reserved for adults, those who did not respond to psychological interventions, and those who had more severe symptoms.

Negative symptoms in the clinical high‐risk state for psychosis: Connection with cognition and primacy in impacting functioning

“…With regard to negative symptoms themselves, these findings bolster the importance of developing interventions at the CHR stage that better address these symptoms. Currently, psychosocial interventions are indicated as the first‐line treatment in the CHR stage of psychosis according to international guidelines (Addington, Addington, Abidi, Raedler, & Remington, ; Schultze‐Lutter et al, ). Despite their success in reducing or delaying the onset of full‐blown psychosis, psychosocial interventions such as cognitive‐behavioural therapy for clinical high‐risk states (CBT CHR ) have not been shown to successfully reduce negative symptoms (eg, Addington et al, ).…”

The reality of at risk mental state services: a response to recent criticisms

“…Antipsychotics are not the usual treatment for ARMS individuals. Australian, Canadian and European guidelines recommend that they only be used in exceptional circumstances, such as if symptoms are severe and progressive and have not responded to psychological therapy (Orygen Research Centre, 2010;Schultze-Lutter et al, 2015;Addington et al, 2017). English guidelines do not recommend them at all (National Institute of Clinical Excellence, 2014).…”

Population profiles of child‐reported psychotic‐like experiences and their differential association with other psychopathologies

“…This structure is consistent over child (Laurens, Hobbs, Sunderland, Green, & Mould, ), adolescent (Carragher et al ., ), and adult populations (Markon, ). The majority of PLEs in the general population are transient (Kaymaz et al ., ) and not pathognomonic for psychotic disorders, though targeted psychological therapy is indicated for childhood PLEs associated with distress or functional impairment (Addington, Addington, Abidi, Raedler, & Remington, ; Kendall, Hollis, Stafford, & Taylor, ). The prevalence of childhood PLEs implies that there are likely to be subgroups with different patterns of PLEs and associated clinical characteristics, only some of whom are likely to benefit from targeted interventions.…”