{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:59:47Z","timestamp":1791223187631,"version":"4.1.0"},"reference-count":52,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2013,2,18]],"date-time":"2013-02-18T00:00:00Z","timestamp":1361145600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:sec id=\"S0033291713000184_sec_a1\"><jats:title>Background<\/jats:title><jats:p>The past two decades have seen exponential clinical and research interest in help-seeking individuals presenting with potentially prodromal symptoms for psychosis. However, the epidemiological validity of this paradigm has been neglected, limiting future advancements in the field.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291713000184_sec_a2\" sec-type=\"methods\"><jats:title>Method<\/jats:title><jats:p>We undertook a critical review of core epidemiological issues underlying the clinical high-risk (HR) state for psychosis and which model of prodromal intervention is best suited for mental health.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291713000184_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>The HR state for psychosis model needs refining, to bring together population-based findings of high levels of psychotic experiences (PEs) and clinical expression of risk. Traditionally, outcome has been attributed to \u2018HR criteria\u2019 alone rather than taking into account sampling strategies. Furthermore, the exclusive focus on variably defined \u2018transition\u2019 obscures true variation in the slow and non-linear progression across stages of psychopathology. Finally, the outcome from HR states is variable, indicating that the underlying paradigm of \u2018schizophrenia light progressing to schizophrenia\u2019 is inadequate.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291713000184_sec_a4\" sec-type=\"conclusion\"><jats:title>Conclusions<\/jats:title><jats:p>In the general population, mixed and non-specific expression of psychosis, depression, anxiety and subthreshold mania is common and mostly transitory. When combined with distress, it may be considered as the first, diagnostically neutral stage of potentially more severe psychopathology, which only later may acquire a degree of diagnostic specificity and possible relative resistance to treatment. Therefore, rather than creating silos of per-disorder ultra-HR syndromes, an early intervention focus on the broad syndrome of early mental distress, requiring phase-specific interventions, may be more profitable.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0033291713000184","type":"journal-article","created":{"date-parts":[[2013,2,19]],"date-time":"2013-02-19T01:21:16Z","timestamp":1361236876000},"page":"17-24","source":"Crossref","is-referenced-by-count":175,"title":["Lessons learned from the psychosis high-risk state: towards a general staging model of prodromal intervention"],"prefix":"10.1017","volume":"44","author":[{"given":"P.","family":"Fusar-Poli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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