**11. Ultrahigh risk**

The PACE ultrahigh-risk (UHR) criteria require that a young person aged between 14 and 30 is referred for health care to the clinic if the criteria for one or more of the following groups are met:


The ultrahigh-risk (UHR) criteria allow the recognition of young people at risk of onset of a psychotic disorder (late adolescence/early adulthood) who also report mental state disorder suggesting an emerging psychotic process or who may have a positive family history of psychosis accompanied by evidence of mental ill health.

Necessarily, criteria have also been developed to define the onset of frank psychosis. These are not identical to DSM-V criteria [22, 23] but are elaborated to define the minimal point at which antipsychotic treatment is indicated. This definition is arbitrary but even has a well-defined treatment implication, applicable equally to "substance-related symptoms, symptoms that have a mood component—either depression or mania—and schizophrenia spectrum disorders." The predictive aim is the first-episode psychosis requiring antipsychotic treatment, arbitrarily defined by the persistence of clear psychotic symptoms, more than 1 week [1, 19].

The intensity of psychotic symptoms characteristic for each of the UHR groups was firstly assessed using the following scales: the "Brief Psychiatric Rating Scale (BPRS) and the Comprehensive Assessment of Symptoms and History (CASH) interview." To specify the frequency and duration of psychotic symptoms, new criteria were needed. So, a new instrument, the Comprehensive Assessment of At Risk Mental States (CAARMS) was designed so that all relevant domains (intensity, frequency, duration, and recency) could be assessed [1, 24].

The PACE UHR criteria have been adopted and adapted in a large number of other settings around the world (USA, UK, Norway, Germany, etc.).

Symptoms associated with prodromal phase.

Yung and McGorry [16] identified eight subtypes of symptoms characteristic of prodromal phase:


Yung and collaborators [19, 25] have elaborated a set of operational criteria to identify individuals at risk for developing a psychotic disorder over the next 6–24 months as Global Assessment of Functioning (GAF) scale score <51, BPRS score >2, and Hamilton Depression Rating Scale (HRDS) score >18 [19, 25].
