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Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00174


  • 1Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
  • 2OASIS Service, South London and Maudsley NHS Foundation Trust, United Kingdom
  • 3Department of Psychiatry, Faculty of Medicine, Dalhousie University, Canada
  • 4Department of Nervous System and Behavioral Sciences, University of Pavia, Italy

Primary prevention in individuals at Clinical High Risk for psychosis (CHR-P) can ameliorate the course of psychotic disorders. Further advancements of knowledge have been slowed by the standstill of the field, which is mostly attributed to its epidemiological weakness. The latter, in turn, underlies the limited identification power of at-risk individuals and the modest ability of CHR-P interviews to rule-in a state of risk for psychosis. In the first part, this perspective review discusses these limitations and traces a new approach to overcome them. Theoretical concepts to support a Psychosis Polyrisk Score (PPS) integrating genetic and non-genetic risk and protective factors for psychosis are presented. The PPS hinges on recent findings indicating that risk enrichment in CHR-P samples is accounted for by the accumulation of non-genetic factors such as: parental and sociodemographic risk factors, perinatal risk factors, later risk factors and antecedents. In the second part of this perspective review we present a prototype of a PPS encompassing core predictors beyond genetics. The PPS prototype may be piloted in the next generation of CHR-P research and combined with genetic information to refine the detection of individuals at-risk of psychosis and the prediction of their outcomes, and ultimately advance clinical research in this field.

Keywords: at risk mental state, Clinical high risk for psychosis (CHR-P), psychosis risk, psychosis, risk prediction, Transition, polygenic risk

Received: 06 Sep 2018; Accepted: 11 Mar 2019.

Edited by:

Tianhong Zhang, Shanghai Mental Health Center (SMHC), China

Reviewed by:

Armando D’Agostino, University of Milan, Italy
Rajiv Radhakrishnan, School of Medicine, Yale University, United States  

Copyright: © 2019 Oliver, Uher and Fusar-Poli. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Paolo Fusar-Poli, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom,