Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comment
. 2021 Jan;51(2):223-227.
doi: 10.1017/S003329172000313X. Epub 2020 Sep 7.

Prevention of psychosis: moving on from the at-risk mental state to universal primary prevention

Robin M Murray  1   2 , Anthony S David  3 , Olesya Ajnakina  4
Affiliations
Comment

Prevention of psychosis: moving on from the at-risk mental state to universal primary prevention

Robin M Murray et al. Psychol Med. 2021 Jan.

Abstract

The value of services for those with the 'At Risk Mental State for Psychosis' (ARMS) continues to be disputed. ARMS services have provided a valuable stimulus to academic research into the transition into psychosis. Furthermore, there is currently a welcome trend to transform such clinics into youth mental health services catering for the broader clientele of young people suffering from anxiety and depression, who already constitute the bulk of those seen at ARMS clinics. However, such services are never likely to make major inroads into preventing psychosis because they only reach a small proportion of those at risk. Evidence from medicine shows that avoiding exposure to factors which increase the risk of disease (e.g. poor nutrition, transmission of infection, tobacco smoking), produces greater public benefit than focussing efforts on individuals with, or about to develop, disease. We consider that the most productive approach for psychosis prevention is avoiding exposure to risk-increasing factors. The best-established risk factors for psychosis are obstetric events, childhood abuse, migration, city living, adverse life events and cannabis use. Some as city living, are likely proxies for an unknown causal factor(s) while preventing others such as childhood abuse is currently beyond our powers. The risk factor for psychosis which is most readily open to this approach is the use of cannabis. Therefore, as an initial step towards a strategy for universal primary prevention, we advocate public health campaigns to educate young people about the harms of regular use of high potency cannabis.

Keywords: At-risk mental state; pathways to care; prevention; psychosis; schizophrenia; transition.

PubMed Disclaimer

Conflict of interest statement

R.M.M. has received honoraria from Janssen, Sunovian, Otsuka, Rekordati and Lundbeck, and is an editor of this journal (Psychological Medicine).

Comment on

References

    1. Ajnakina, O., David, A. S., & Murray, R. M. (2018). At risk mental state' clinics for psychosis - an idea whose time has come - and gone! Psychological Medicine, 49, 529–534. - PubMed
    1. Ajnakina, O., Morgan, C., Gayer-Anderson, C., Oduola, S., Bourque, F., Bramley, S., … David, A. S. (2017). Only a small proportion of patients with first episode psychosis come via prodromal services: A retrospective survey of a large UK mental health programme. BMC Psychiatry, 17, 017–1468. - PMC - PubMed
    1. Alison, A., Bastiampillai, T., Malhi, G. S., & Castle, D. (2019). Does early intervention prevent chronic psychosis? A question for the victorian royal commission into mental health. Australian & New Zealand Journal of Psychiatry, 53, 943–945. - PubMed
    1. Anglin, D. M., Galea, S., & Bachman, P. (2020). Going upstream to advance psychosis prevention and improve public health. JAMA Psychiatry, 77, 665–666. - PubMed
    1. Arango, A., Diaz-Caneja, C., McGorry, P., Rappaport, J., Sommer, I., Vorstman, J. A., … Carpenter, W. (2018). Preventive strategies for mental health. The Lancet. Psychiatry, 5, 591–604. - PubMed

Publication types