Early Identification and Interventions of Attenuated Psychosis Syndromes in Spain

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During the last 10 years, early intervention in psychosis programs has been implemented by the Public Health System (PHS) in some of the 17 autonomous communities of Spain. Most of these programs have focused on assessment and intervention in patients with first episode psychosis (FEP), with only a minority including participants with an attenuated psychosis syndromes (APS). These are recruited both through self-referrals by help-seeking patients and through strategies actively seeking to recruit APS from within the community. In the existing programs so far, identification of APS is performed with the Structured Interview of Prodromal Symptoms (SIPS) and Scale of Prodromal Symptoms (SOPS), and Comprehensive Assessment of At-Risk Mental Status (CAARMS), translated into Spanish. Intervention approaches are documented in clinical practice guidelines sponsored by PHS authorities. Although there are some common features across the different programs such as first-line psychological treatments, there are other aspects, such as type of psychotherapy delivered or the indication or type of pharmacological treatments, which vary across programs. Thus, there is substantial variability in the assessment and intervention received by patients with APS throughout Spain. Research in patients with attenuated psychotic symptoms has grown exponentially in Spain in recent years, employing clinical, cognitive, hormonal, immunological, and neuroimaging measures, and has added to the collective body of research characterizing the APS and predictors of transition to psychosis. An illustration of a typical APS case with some characteristic features of current Spanish society is also presented.