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).