Research Guidelines

• Further research is undeniably required to determine which treatment strategies may be effective in reducing the current burden of symptoms and disability in ''at-risk mental states'' and further in reducing risk for progression to frank psychosis and a diagnosis of a persistent psychotic disorder, most commonly schizophreniform disorder or schizophrenia.

• Such research must meet the highest ethical standards for medical research; no more and no less than is required for early intervention research in other medical fields. Patients must be fully competent, give true informed consent, and be free to withdraw from such research at any time. Non-participation in research should in no way affect access to clinical care if this is desired and judged to be appropriate. Any potential sources of harm to the patient in such research must be minimized such as reducing stigma. In fact minimizing stigma is a key consideration to providing clinical care to such patients, irrespective of whether they participate in research. For example, if a specialized clinical service is established for ''at-risk'' patients, it should be a primary care setting and/or possess a generic title if possible. Ultimately, engaging patients during this phase of illness has the potential to reduce stigma even if psychosis does supervene, since duration of untreated psychosis (DUP) can be reduced to minimal levels, and hospitalization and disruption to lifestyle are usually markedly less. This reduces the extent of labelling and consequent stigma.

• If research in this phase is carried out in non-Western cultures, it should be led or heavily informed by local clinicians and researchers, so that culturally normal experiences and behaviours are not mislabelled as pathological psychosis. In fact, this is the key task in Western cultures too. However, it is presumed that the risks may be higher when cross-cultural factors come into play. In multicultural developed societies this problem must also be carefully addressed.

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