Can we prevent psychosis? The ineffective paradigm of indicated psychosis prevention

Major improvements in the effectiveness of care for people with psychosis are essential, because these disorders still cause tremendous disability, despite advances in treatment to date. There are three sub-domains of primary prevention for mental disorders: universal prevention, selective prevention and indicated prevention (https://www.who.int/mental_health/publications/prevention_mh_2004/en/). Universal prevention targets the general public or a whole population. Selective prevention targets individuals or subgroups of populations whose risk of developing mental disorder is significantly higher than average. Indicated prevention targets high-risk people identified as having minimal or detectable signs or symptoms foreshadowing mental disorder or biological markers indicating predisposition to mental disorder. Universal and selective prevention for psychosis have not appeared possible to date. Accordingly, researchers and clinicians have explored the potential to prevent psychosis, through indicated prevention, which is targeted at people with minimal or detectable signs or symptoms foreshadowing psychosis. However, the weight of evidence to date indicates that the paradigm of indicated prevention has not been found to be effective. In this context, research into improved care for people with psychosis might benefit from new paradigms that address secondary (early detection and treatment of diagnosed disorders) and tertiary prevention (reduction of recurrence/relapses, disability and enhancement of rehabilitation).