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Clinical Staging model for Psychosis Definition Increased risk of psychosis No symptoms currently Phase Premorbid 1a Mild or non-specific symptoms of psychosis, including neurocognitive deficits. Mild functional change or decline Possible prodrome 1b Ultra-high risk of psychosis: Moderate but sub-threshold symptoms, with moderate neurocognitive changes and functional decline to caseness or chronic poor functioning (≥30% drop in SOFAS in previous 12 months OR <50 for previous 12 months) First episode of psychotic disorder: Full threshold disorder with moderate-severe symptoms, neurocognitive deficits and functional decline (GAF 3050) Includes acute and early recovery periods Incomplete remission from first episode of care Possible prodrome Recurrence or relapse of psychotic disorder which stabilises with treatment but at a level of GAF, residual symptoms, or neurocognition below the best level achieved following remission from first episode Multiple relapses, with objective worsening in clinical extent and impact of illness Late/incomplete recovery 0 2 3a 3b 3c Acute and early recovery Late/incomplete recovery Late/incomplete recovery Potential Interventions Indicated prevention of FEP • Improved mental health literacy • Family education, drug education • Brief cognitive skills training Indicated secondary prevention of FEP • Formal mental health literacy • Family psychoeducation, formal Cognitive Behavioural Therapy (CBT) • Active reduction of substance misuse Indicated secondary prevention of FEP • Psychoeducation, formal CBT • Active reduction of substance misuse • Omega-3 fatty acids • Atypical antipsychotic agents • Antidepressant agents or mood stabilisers Early intervention for FEP • Psychoeducation, formal CBT • Active reduction of substance misuse • Atypical antipsychotic agents • Antidepressant agents or mood stabilisers • Vocational rehabilitation Early intervention for FEP As for ‘2’, but with additional emphasis on medical and psychosocial strategies to achieve full remission Early intervention for FEP As for ‘3a’, but with additional emphasis on relapse prevention and ‘early warning signs’ strategies Early intervention for FEP As for ‘3b’, but with emphasis on longterm stabilisation 4 Severe, persistent OR unremitting Chronicity As for ‘3c’, but with emphasis on illness as judged by symptoms, clozapine, other tertiary treatments, neurocognition and disability and social participation despite ongoing criteria disability Adapted from McGorry, P.D., et al., Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Aust N Z J Psychiatry, 2006. 40(8): p. 616-22.