Identifying people at risk of psychosis

One-third of people identified as being at risk of psychosis (prodromal stage of psychosis) experience a full psychotic episode within 3 years; most episodes occur within the first year. Identify people at risk of developing psychosis to:

• enable treatment to be started immediately to reduce the risk or minimise the impact of a full psychotic episode developing
• reduce the risk of suicide and self-harm—two-thirds of people at risk of psychosis have suicidal thoughts, half self-harm and almost one-fifth attempt suicide.

A person is considered at risk of psychosis if they have recently experienced significant functional decline or have longstanding poor function and have any of the following features:

• one or more episodes of transient positive symptoms lasting less than a week that have spontaneously remitted—people displaying these symptoms are at highest risk of developing a full psychotic episode
• attenuated psychotic symptoms (eg unusual perceptual experiences, odd beliefs, disorganised speech) lasting longer than a week
• personality disorder with schizotypal traits
• a family history of a psychotic disorder.

People at risk of psychosis are typically aged between 14 and 35 years and often have other psychiatric comorbidities (eg depression, anxiety, substance use); these should be treated.