Q: Why do we us the acronym “CARPP” with and image of a Koi carp? A: CARPP stands for Cognitive & Affective Risk & Protection in Psychosis. Also, it is widely believed that the Japanese associate koi (also known as carp) with perseverance in adversity and strength of purpose. Because of its strength and determination to overcome obstacles, it stands for courage and the ability to attain high goals. Just what we all want for young people with 22q11.2DS