What Does it Mean to Be at "Clinical High Risk?"

“Prodrome” or Clinical High Risk (CHR) refers to the early symptoms of an illness which alert us to the fact that a young person may be at a higher risk of developing a fully developed psychotic disorder, or a period of disturbance which represents a deviation from a person’s previous experience and behaviors. ?

Certain constellations of prodromal symptoms have recently been shown to predict the onset of psychosis with a high degree of accuracy, thus making treatment intervention in the prodromal phase more feasible scientifically and ethically. Schizophrenia and other psychotic disorders are often preceded by prodromal changes, lasting for periods ranging from several days to several years, which foreshadow the onset of illness. The prodromal phase is potentially important in defining markers of risk for progression to psychotic illness and investigating novel biological and psychological treatments to prevent a transition to psychosis. Early identification of symptoms leads to a better prognosis not only in the short term but even in long term. ?

It is essential to have a specialized assessment carried out to determine whether the person actually meets criteria for the clinical high risk phase. We should recognize that youth meeting clinical high risk criteria are help seeking and in need of care whether or not they develop a full psychotic disorder. Those in high risk should be monitored closely for progression to full psychosis through monthly assessments. Co-existing conditions such as anxiety and depression should be treated as appropriate. It’s important to provide psychosocial support and include the family in the services.

What are some of the behaviors of concern that could be indicative of prodromal syndromes?

You are looking for a change in the young person – either the beginning or worsening of: ?

Withdrawal/Isolation;
Social Difficulties;
Poor Hygiene;
Bizarre Behavior/Appearance;
Increased difficulty at school or work;
Falling Asleep in Class Repeatedly;
Sadness/Tearfulness;
Excessive Anxiety;
Absenteeism/Staying in Room;
Poor Concentration/Spacing Out/Difficulty thinking clearly;
Hypervigilance;
Decrease in Work Performance/Activity Level;
Becoming Neglectful and Unfeeling;
Suspiciousness or mistrust of others;
Changes in the way things look or sound;
Emotional Outbursts/Emotional Flatness

Frequently Asked Questions

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If someone is Clinically High Risk for Psychosis, does that mean they are psychotic or have a psychotic diagnosis?
If someone is Clinically High Risk for Psychosis, does that mean they will eventually become psychotic?
Will my child be required to participate in research if they come to the PRIME Clinic?
Will I have to stop treatment with my current therapist or doctor to be seen at the PRIME Clinic?
Will I be required to take medication if I come to the PRIME Clinic?
I am still eligible for the evaluation at the PRIME Clinic if I am already taking psychiatric medications?
Do I have to participate in group therapy if I come to the PRIME Clinic?
Does my child need a referral from their physician to be seen at then PRIME Clinic?

If someone is Clinically High Risk for Psychosis, does that mean they are psychotic or have a psychotic diagnosis?: No. The experiences a person has who is Clinically High Risk are similar to psychotic symptoms in the sense that they are symptoms more commonly seen in psychosis diagnosis. However, someone who is Clinically High Risk (or "CHR") does not have the same level of frequency or severity as someone who has a psychotic disorder. Therefore, they do not meet criteria for a psychotic disorder.
If someone is Clinically High Risk for Psychosis, does that mean they will eventually become psychotic?: No. In fact, the research on this shows that there is more of a chance that the individual does not develop a psychotic diagnosis. One of the most important things a person can do who is Clinically High Risk is to receive early intervention treatment. Studies also show that those who receive early intervention treatment are far less likely to develop a psychotic disorder. ?

Being Clinically High Risk means that an individual is showing signs and symptoms that are a warning sign of a more series illness developing. However it is not a guarantee. Think of it this way: if you went to the doctor and they said you had "borderline high cholesterol" what they are saying is that it is possible that high cholesterol develops, but you're not quite there. If you correct your diet and exercise more, there is a good chance that you will no longer have borderline high cholesterol. What you do from this moment going forward is going to be crucial to your getting well. This is the same case for those who are Clinically High Risk. Early intervention is important, and that is what the PRIME Clinic specializes in.
Will my child be required to participate in research if they come to the PRIME Clinic?: No. The PRIME Clinic is both an Outpatient Treatment Clinic and a Research Clinic. You and your child have the option to participate in either or both.
Will I have to stop treatment with my current therapist or doctor to be seen at the PRIME Clinic?: No. We will work with you and your providers to develop the most effective treatment plan based on your preferences and needs.
Will I be required to take medication if I come to the PRIME Clinic?: No. The PRIME Clinic does offer medication management as a treatment option if you desire, but it is not a requirement.
I am still eligible for the evaluation at the PRIME Clinic if I am already taking psychiatric medications?: Yes. You are still eligible for evaluation and treatment at the PRIME Clinic if you are already taking a prescribed medication. However, some prior psychiatric diagnosis may impact your eligibility.
Do I have to participate in group therapy if I come to the PRIME Clinic?: No. The PRIME Clinic does offer Support Groups as a treatment option for individuals and/or their families, but participation is not a requirement.
Does my child need a referral from their physician to be seen at then PRIME Clinic?: No. You can call 203-785-2100 directly for an intake screening call to determine if an evaluation at the PRIME Clinic is a good option for your child or you can fill out the screening form and we will get back to you quickly.