A Four-Country Project funded within the Fifth Framework Programme “Quality of Life and Management of Living Resources” of the European Commission, Action Line 10.1 "Public Health"
(Contract N° QLG4-CT-2001-01081)

The long duration of untreated illness in early psychosis calls for intensive efforts for early detection of psychotic disorders. Recent findings suggest that the early recognition and intervention in prodromal stages may help to prevent, or at least delay, the progression to acute levels. Moreover, a shorter duration of untreated illness may well result in an improvement of the long-term outcome, minimisation of the distress experienced by sufferers and their families, and a reduction of the heavy burden imposed on the health care systems.

EPOS, the "European Prediction of Psychosis Study", marks the first European multi-centre effort on early recognition and intervention for persons at risk for psychosis, particularly schizophrenia. EPOS is a collaborative study of six University departments in Germany (Cologne/Berlin), Finland (Turku), The Netherlands (Amsterdam), and the UK (Birmingham/Manchester). Thus, the study will provide an unique data set on persons of high risk for psychosis in different European countries and health systems.

EPOS is designed to predict the transition to psychosis and the course of psychopathology - clinical, neurocognitive, and neurobiological measures - in a large, pan-European sample of persons at risk for psychosis. As another innovative approach, the disabilities and quality of life of persons at risk for psychosis are for the first time prospectively assessed to detect the onset, prevalence, and determinants of deficits and needs in these stages. EPOS also aims at the assessment of pathways and obstacles to care, and calculates delays to adequate treatment. Any interventions offered, e.g. psychological or pharmacological treatments, and their outcome will be monitored and evaluated.

All in all this prospective longitudinal field-study took so far more than 54 months. Each participating centre recruited about 50 persons (subcontractors 25 persons) at risk for psychosis. The presence of intermittent or attenuated psychotic symptoms, a genetic risk plus decline in functioning, or subtle self-perceived cognitive and perceptual deficiencies defined an at-risk state. Persons with psychotic symptoms for more than 1 week were excluded. The participants underwent a multi-level assessment of past and present psychopathology, personality, neurocognitive, neurophysiological, and structural brain abnormalities. Pathways to care, disabilities, and quality of life were also assessed at inception, and at the follow-ups after 9 and 18 months. By means of specially designed instruments, the received treatments and treatment costs were documented.

EPOS has yielded large samples and extensive data allowing for comprehensive evaluation, comparison and prognosis of psychopathology, neurobiology, disability, and pathways to care in persons at risk for psychosis in different European regions. Furthermore, the obtained data are used to determine a “risk profile” with regard to the transition to psychosis. The systematic monitoring of interventions not only allows for a calculation of treatment costs for prodromal persons, but also forms an empirical data base for controlled clinical trials in the future.

The official starting date for EPOS was December 1st, 2001. In the first five years of the study, more than 250 persons possibly at risk for psychosis were recruited by all participating centres, EPOS thus presently being the largest study worldwide in this field. Moreover, the participating centres have successfully finalized the 1st and 2nd follow-up assessments of a substantial part of probands incepted.

The European Prediction of Psychosis Study (EPOS) has been presented to national and international scientific audiences at various occasions. In the past year, EPOS has been most prominently presented at the 5th International Conference on Early Psychosis (IEPA), Birmingham/UK, October 4th – 6th, 2006, and the 15th Congress of the Association of European Psychiatrists (AEP), Madrid/Spain, March 17th – 21st, 2007, among others.

Detailed overview on the design of the study:
The European Prediction of Psychosis Study (EPOS): integrating early recognition and intervention in Europe. J. Klosterkötter, S. Ruhrmann, F. Schultze-Lutter, R. K. R. Salokangas, D. Linszen, M. Birchwood, G. Juckel, A. Morrison, J. L. Vazquez-Barquero, M. Hambrecht, H. von Reventlow on behalf of the EPOS Group. World Psychiatry, 4(3), 2005, p.161 – 167 (English version), and 3(3), 2005, p. 161 – 166 (Spanish version).

Homepage: www.epos5.org

Cologne (Co-ordinating Centre)
Professor  J. Klosterkötter, MD
Department of Psychiatry & Psychotherapy
University of Cologne
Joseph-Stelzmann-Straße 9
50924 Cologne/Germany
Phone: ++49-(0)221-478-4010
Fax: ++49-(0)221-478-5593

Stephan Ruhrmann, MD
Department of Psychiatry & Psychotherapy
University of Cologne
Joseph-Stelzmann-Straße 9
50924 Cologne/Germany
Phone: ++49-(0)221-478-4010
Fax: ++49-(0)221-478-5593
Professor Raimo K.R. Salokangas, MD, PhD, MSc
TUCH,  Psychiatric Clinic
20520 Turku/Finland
Phone: ++358 2 2611 740
Fax: ++358 2 2612 730
Professor Don Linszen, MD
Academic Medial Centre
Tafelbergweg 25
1105 BC Amsterdam Zuidoost,
The Netherlands
Phone: ++31 20 566 7254
Fax: ++31 20 691 9139
Professor Max Birchwood, PhD
Early Intervention Service
Harry Watton House
97 Church Lane
Aston, Birmingham B6 5UG UK
Phone: ++ 44 121 685 6479
Fax:  ++ 44 121 685 6049

Berlin (subcontractor  to Cologne)
Georg Juckel, MD
Charité, Department of Psychiatry
Humboldt University Berlin

Schumannstraße 20/21
10117 Berlin/Germany
Phone:  ++49-(0)30-450 517 042
Fax: ++49-(0)30-450 517 922

Manchester (subcontractor to Birmingham)
Anthony Morrison, PhD
Department of Psychology
The Victoria University of Manchester
Oxford Road
Manchester M13 9PL
Phone: ++ 44 161 275 2554
Fax: ++ 44 161 275 2623
EPOS Project Management
Heinrich Graf v. Reventlow, Dipl.Psych., MA
Department of Psychiatry & Psychotherapy
University of Cologne
Joseph-Stelzmann-Straße 9
50924 Cologne/Germany
Phone: ++49-(0)221-478-7225
Fax: ++49-(0)221-478-5593
EPOS Consultant
Prof. Martin Hambrecht, MD, PhD
Prof. José Luis Vàzquez-Barquero, MD, PhD, FRCPsych
EPOS Scientific Advisory Board
Prof. Martin Knapp, PhD
London /UK
Prof. Shôn Lewis, MD, PhD
Prof. Thomas McGlashan, MD
Prof. Patrick McGorry, MD, PhD
FETZ Cologne

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