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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.