Toward Prevention Approaches for Schizophrenia: An Overview of Prodromal States, the Duration of Untreated Psychosis, and Early Intervention Paradigms

Abstract

<p>Serious mental illnesses are extremely detrimental to overall health and productivity and are associated with substantial disability throughout the world. Schizophrenia, which occurs in all populations with a prevalence in the range of 1.4 to 4.6 per 1,000 people, is one of the most severe mental illnesses. Schizophrenia and other serious mental illnesses traditionally have not been considered widely from the perspective of public health and prevention. Yet in recent decades, schizophrenia researchers increasingly have become interested in prevention-oriented considerations, as evidenced by the growth in research centers focusing on the early course of schizophrenia and even the prodrome of schizophrenia. In addition to the goals of secondary and tertiary prevention, ongoing elucidation of risk factors for the illness, as well as the genetics underlying its well-characterized heritability, indicate that primary prevention someday may be an attainable goal.</p><h4>ABOUT THE AUTHORS</h4><p>Michael T. Compton, MD, MPH, is Assistant Professor, Emory University School of Medicine Department of Psychiatry and Behavioral Sciences and Department of Family and Preventive Medicine, and Rollins School of Public Health of Emory University, Department of Behavioral Sciences and Health Education, Atlanta, Georgia. Thomas H. McGlashan, MD, is with the Yale University School of Medicine Department of Psychiatry, New Haven, Connecticut. Patrick D. McGorry, MD, is Executive Director, ORYGEN Research Centre, ORYGEN Youth Health, Parkville, Victoria, Australia.</p><p>Address correspondence to: Michael T. Compton, MD, MPH, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, SE, Room #333, Atlanta, GA 30303; fax: 404-616-3241; email: <a href="mailto:mcompto@emory.edu">mcompto@emory.edu</a>.</p><p>The authors disclosed no relevant financial relationships.</p> <h4>EDUCATIONAL OBJECTIVES</h4> <ol> <li>Describe the clinical features of the prodrome of schizophrenia.</li> <li>Explain the importance of early intervention efforts aimed at reducing the duration of untreated psychosis.</li> <li>Discuss how psychiatrists can apply a prevention perspective when treating people who are in the early course of schizophrenia.</li> </ol>