**16. Predictors of psychotic disorder in high-risk groups**

Since 2004, many prospective programs focused on early psychoses have been developed.

The term "at risk mental state" (ARMS) is still used today to describe individuals at risk to develop a psychotic disorder [1, 44]. So, different diagnostic systems have been achieved, one of the most known and sophisticated systems being developed by McGorry and his team (1966) in order to reduce the number of "false positive" cases [1, 44]. The diagnostic system accomplished by McGorry et al. has three categories of diagnostic criteria for individuals' "at risk mental state" (ARMS):

	- a.The presence of at least one of the following: ideas of reference, odd beliefs, magical thinking, perception disturbances, paranoid ideation, formal thought disorder, disturbances of receptive language.
	- b.Frequency of symptoms: several times a week.
	- c.Duration: have experienced subthreshold, attenuated positive psychotic symptoms during the past year.
	- d.Recently: stressful life events during the last year.
	- a.Transient psychotic symptoms: the presence of at least one of the following—ideas of reference, odd beliefs, magical thinking, perception disturbances, paranoid ideation, formal thought disorder, disturbances of receptive language.
	- b.Frequency of symptoms: few times a week.
	- c.Duration: less than a week and spontaneously abated.
	- d.Recently: short intermittent psychotic symptoms were present during the previous year.
	- a.First-degree relative with a psychotic disorder or the identified individual with a schizotypal personality disorder.

**41**

*Schizophrenia: Early Recognition and Prevention DOI: http://dx.doi.org/10.5772/intechopen.88537*

symptoms, disorganization, and positive symptoms.

been found to be predictive of psychosis [1].

significant predictors of psychosis [19, 46, 47].

countries around the world: USA, UK, Germany, and Finland.

more is required, plus the PACE trait and state risk UHR criterion.

One or more of the following basic symptoms:

• Disturbances of visual and auditory perception

• Disturbances of receptive language (either heard or read)

schizophrenia.

tolerance to stress [24].

prodrome [48, 49].

**16.1 The EIPS criteria**

(unstable)

true memory

b.Significant decline in functioning during the previous year.

c.Duration: at least 1 month and no more than 5 years [19, 22].

These criteria were criticized for the absence of negative symptoms of

Cornblatt et al. mentioned, among the diagnostic criteria of the prodrome, negative attenuated symptoms or disorganization, which define clinical high-risk (CHR) group representing the early prodromal stage and CHRT group representing tardive prodromal stage [45]. CHRT group is characterized by negative attenuated

Negative symptoms are impaired concentration and attention, subjectively abnormal emotional experiences, blunted affect, impaired energy, and impaired

Marked impairment in role functioning, flat or inappropriate affect, anhedonia, and asociality were found at significantly higher levels at baseline in those who went on to develop psychosis than in those who did not [26]. So, negative symptoms have

Positive symptoms like unusual thought content, suspiciousness, perceptual disturbance, conceptual disorganization, and disorganized communication are

The ultrahigh-risk (UHR) criteria have been used and modified in different

The German Research Network on Schizophrenia (GNRS), Cologne, Bonn, Düsseldorf, and Munich, introduced the basic symptoms into the definition on the

The basic symptoms included thought interferences, perseveration, pressure or blockages, and disturbances of receptive language; decreased ability to discriminate between ideas and perception or fantasy and true memories; unstable ideas of reference; derealization; and visual or auditory perceptual disturbances. Using these basic symptoms, it should be possible to identify subjects at risk of developing schizophrenia, and so early intervention is possible. Because basic symptoms were frequently found before any subthreshold or attenuated psychotic symptoms, these criteria were thought to be detecting the very beginning of the initial prodromal phase [50]. Unlike McGorry et al., the GNRS distinguishes between the "early initial prodromal state" (EIPS) and the "late initial prodromal state" (LIPS). The EIPS criteria attempt to define a group at incipient but not imminent or immediate risk of psychosis. The criteria consist of the 10 predictive basic symptoms of which one or

• Thinking disturbances: perseveration, pressure, blockage, ideas of reference

• Diminished capacity to discern between ideas and perception, fantasy, and

*Neurodevelopment and Neurodevelopmental Disorder*

future studies.

developed.

of participants not developing psychotic disorder. Consequently, some persons will be "diagnosed" and treated as if they were at "high risk" of psychosis, when this may not be true. This false identification may have negative consequences on those individuals: they may become anxious or depressed about the possibility of developing schizophrenia or receiving treatment, stigmatized by others or themselves or both [39]. These people may be exposed to drug or other therapies, with potential adverse effects without gaining any benefit [39, 40–43]. This controversy on the risk benefit balance of early intervention strategies must be addressed by

Since 2004, many prospective programs focused on early psychoses have been

a.The presence of at least one of the following: ideas of reference, odd beliefs, magical thinking, perception disturbances, paranoid ideation,

c.Duration: have experienced subthreshold, attenuated positive psychotic

a.Transient psychotic symptoms: the presence of at least one of the following—ideas of reference, odd beliefs, magical thinking, perception disturbances, paranoid ideation, formal thought disorder, disturbances of

d.Recently: short intermittent psychotic symptoms were present during the

a.First-degree relative with a psychotic disorder or the identified individual

formal thought disorder, disturbances of receptive language.

b.Frequency of symptoms: several times a week.

d.Recently: stressful life events during the last year.

b.Frequency of symptoms: few times a week.

with a schizotypal personality disorder.

2.Brief limited intermittent psychotic symptoms group (BLIPS).

c.Duration: less than a week and spontaneously abated.

The term "at risk mental state" (ARMS) is still used today to describe individuals at risk to develop a psychotic disorder [1, 44]. So, different diagnostic systems have been achieved, one of the most known and sophisticated systems being developed by McGorry and his team (1966) in order to reduce the number of "false positive" cases [1, 44]. The diagnostic system accomplished by McGorry et al. has three categories of diagnostic criteria for individuals' "at risk mental state" (ARMS):

**16. Predictors of psychotic disorder in high-risk groups**

1.Attenuated psychotic symptoms (APS).

symptoms during the past year.

receptive language.

previous year.

3.Trait and state risk factor group.

**40**

b.Significant decline in functioning during the previous year.

c.Duration: at least 1 month and no more than 5 years [19, 22].

These criteria were criticized for the absence of negative symptoms of schizophrenia.

Cornblatt et al. mentioned, among the diagnostic criteria of the prodrome, negative attenuated symptoms or disorganization, which define clinical high-risk (CHR) group representing the early prodromal stage and CHRT group representing tardive prodromal stage [45]. CHRT group is characterized by negative attenuated symptoms, disorganization, and positive symptoms.

Negative symptoms are impaired concentration and attention, subjectively abnormal emotional experiences, blunted affect, impaired energy, and impaired tolerance to stress [24].

Marked impairment in role functioning, flat or inappropriate affect, anhedonia, and asociality were found at significantly higher levels at baseline in those who went on to develop psychosis than in those who did not [26]. So, negative symptoms have been found to be predictive of psychosis [1].

Positive symptoms like unusual thought content, suspiciousness, perceptual disturbance, conceptual disorganization, and disorganized communication are significant predictors of psychosis [19, 46, 47].

The ultrahigh-risk (UHR) criteria have been used and modified in different countries around the world: USA, UK, Germany, and Finland.

The German Research Network on Schizophrenia (GNRS), Cologne, Bonn, Düsseldorf, and Munich, introduced the basic symptoms into the definition on the prodrome [48, 49].

The basic symptoms included thought interferences, perseveration, pressure or blockages, and disturbances of receptive language; decreased ability to discriminate between ideas and perception or fantasy and true memories; unstable ideas of reference; derealization; and visual or auditory perceptual disturbances. Using these basic symptoms, it should be possible to identify subjects at risk of developing schizophrenia, and so early intervention is possible. Because basic symptoms were frequently found before any subthreshold or attenuated psychotic symptoms, these criteria were thought to be detecting the very beginning of the initial prodromal phase [50].

Unlike McGorry et al., the GNRS distinguishes between the "early initial prodromal state" (EIPS) and the "late initial prodromal state" (LIPS). The EIPS criteria attempt to define a group at incipient but not imminent or immediate risk of psychosis. The criteria consist of the 10 predictive basic symptoms of which one or more is required, plus the PACE trait and state risk UHR criterion.
