Understanding the genesis of psychotic disorder: Issues in the prediction and prophylaxis of those at ultra‐high risk

Purpose. Recent research is starting to identify individuals at an increased risk of developing a psychotic disorder. This review seeks to identify the ‘state of the art’ with respect to the clinical identification and treatment of individuals at ‘ultra‐high risk’. Method. The research and clinical literature are reviewed with respect to a wide range of predictors relevant across development. Results. The review draws on evidence from childhood and adolescence to suggest that a range of biological, cognitive, personality, and social features are predictive of, but often not specific to, psychosis within the context of the diathesis‐stress model. Much evidence supports the view that environmental stressors act in combination with vulnerability factors to increase risk of transition, often during late adolescence and early adulthood. Conclusions. Recent clinical research has used both retrospective and prospective means of identifying individuals at ultra‐high risk and has made substantial gains in predicting transition. The clinical implications of their identification are discussed in the context of current pharmacological and psychosocial treatment studies. However, significant unresolved clinical and ethical issues remain with both types of study.