Clinical High Risk Psychosis: Issues of Diagnostics and Therapy

Abstract

The aim of the review: the analysis of modern Russian and foreign literature dedicated to the problem of determining diagnostic criteria for clinical high risk of psychosis (CHR-P) and outlining the therapeutic approaches based on the pathogenic mechanisms of their development. Material and method: the publications found by searching queries for keywords in Russian and English in the MEDLINE/PubMed and eLIBRARY databases for the time period from 2010 to 2020 were then analyzed. Conclusion: the review presents a modern definition of the CHR-P group, along with a clarification of individual diagnostic criteria, which include attenuated psychotic symptoms (APS), brief limited intermittent psychotic symptoms (BLIPS), genetic risk with deterioration of premorbid functioning, as well as basic symptoms (BS). We found heterogeneity of the CHR-P group with different levels of manifestation and outcomes and indicated the involvement of different pathogenic mechanisms in their formation. These findings determine the development of various approaches to treatment, which involve the assessment of the ratio of potential benefits and the risks of side effects. The obtained data, on the one hand, attest to the prospective viability of the therapeutic approach to the patients with CHR-P with the possibility of influencing the course of the disease, delaying its manifestation and improving long-term outcomes, and, on the other hand, the lack of universal standards of therapy at present. Tactics of treatment are determined basing on an individual approach to the patient with a comprehensive psychopathological assessment of complaints, clinical state and its dynamics.