Early Intervention and the Treatment of Prodrome in Schizophrenia

Abstract

Strategies for preventing the development of schizophrenia are in their infancy but are associated with much hope and potential. The relatively long prodrome in schizophrenia allows for indicated prevention as an effective intervention. "High-risk" individuals have subtle symptoms and, without intervention, a third would develop psychosis within 1 year, and many will have poor functional outcomes, even in the absence of psychosis. Research in this area is preliminary but encouraging. A literature search was performed using databases including PubMed, PsychInfo, and Cochrane, as well as a search of individual journals through cross-referencing. The search used the following key words: schizophrenia, psychosis, psychotic disorders, first episode, early, prodrome, prodromal, prevention, ultra high risk, at risk, and intervention. Strategies for preventing the development of schizophrenia are divided into universal, selective, and indicated levels of prevention. The common preventive methods include treatment with antipsychotic medications and psychotherapy. Early intervention helps at risk individuals with symptom reduction and appears to delay conversion to full blown psychosis. However, the criteria for identifying at risk individuals have low predictive value, which raises concerns about unnecessary and potentially harmful interventions. Although a range of interventions appear to be effective in reducing rates of transition to psychosis, they are inadequately differentiated and require further study. Current data suggest that clinicians take an individualized approach to intervention, considering the risk-benefit ratio on a case-by-case basis.