Background

These are based on the following facts in the field of indicated prevention of psychosis:

• There are well-known operationalized criteria of the clinical high-risk (CHR) stage for psychosis.
• There are validated criteria for prognosis. They were developed in the PRONIA project and validated on external data.
• Therapy has been proven to be highly effective as indicated prevention in CHR patients. Cognitive behavioral therapy is helpful in preventing the onset of psychosis.

Still, there is a lack of indicated prevention in Germany – and Europe – as there are hardly any specialized early detection services, that offer efficient indicated prevention for CHR patients.

The current care system in Germany – also in Europe – often leads to uncoordinated help-seeking behavior with very cost-intensive services and examinations with a simultaneous lack of therapeutic success in the field of psychosis. The goal of the CARE-study is, for the first time, to provide an efficient technical staged treatment pathway, in which the efficiency of both, the specific diagnostic process and the individual and specific therapy adapted to the diagnostic process, is increased. This new form of care is currently undergoing clinical trials. CARE intends to prevent the transition of patients into manifest psychosis and to improve the prognosis, while demonstrating lower healthcare costs in the population at risk.

The future CARE Schema will include a new form of computer-based diagnostic and risk-adapted treatment. This includes in-depth clinical diagnostics, two AI-based risk evaluations with

1) a quantified individual risk evaluation of the conversion into psychosis and

2) a individual quantified risk evaluation of further decline of social functioning in the next 12 Months of the patient. 

This is connected to a specific newly developed quantified risk-evaluation -adapted intervention (IPPI) for high-risk patients of psychosis (based on cognitive Therapy) and medical treatment. The IPPI therapy focuses on the main and specific domains of the high-risk state of psychosis.

The term „translation“ refers to the “bench-to-bedside” enterprise: For this area of research, the endpoint is the production of a promising new treatment that can be utilized clinically or commercialized (“brought to market”).

Many factors are important for a successful translation. The key requirement consists of a tight network of partners.

Psychiatric disorders mainly develop in adolescence and young adulthood. Therefore, a tight cooperation between child and adolescent psychiatry and adult psychiatry to establish the strong national network CARE was the most important element. For the first time, interdisciplinary Early Recognition and Therapy Centers (“Früherkennungszentren”, FETZ) for child and adolescent psychiatry and adult psychiatry formed.

Further, a strong support from both, national professional societies, adolescent and adult psychiatry, is of high value.

A strong support from the stakeholders of our health insurances – in our network the partners of the Techniker Krankenkasse NRW, the DAK-Gesundheit and AOK Rheinland/Hamburg – is absolutely needed, and their conviction that the translation can succeed.

Early recognition and prevention is not possible without a tight cooperation with experts of ethics in medicine. This was implemented with the center of life ethics Bonn and experts of social psychiatry from the university of Leipzig.

Finally, we are linked in a tight cooperation with the departments of health economics, university Wuppertal and the health insurances with their databases and patients files.

The network CARE represents the future program of preventive psychiatry. This includes:

• future high diagnostic standards and trainings in early recognition of psychosis,
• future implementation of predictive models with computer-based medical devices that support the approach of personalized preventive psychiatry
• future trainings of AI-based diagnostics and ethical appropriate communication
• future high therapeutic standards and supervision of interventions
• future privacy and technical documentation

What can we offer to other Researchers and Clinicians in Germany and other countries?

• Cooperations in research and
• Cooperations regarding supply structures in psychiatric health care and preventive psychiatry
• Consulting

For inquiries regarding collaborations and research, please contact one of the following:

Univ. Prof. Dr. med. Eva Meisenzahl (eva.meisenzahl@lvr.de)

Prof. Dr. Nikolaos Koutsouleris (nikolaos.koutsouleris@med.uni-muenchen.de)

PD Dr. Frauke Schultze-Lutter (frauke.schultze-lutter@lvr.de)