“Early detection and prevention of schizophrenia”

The “entrenched level of disability” often associated with schizophrenia often occurs prior to the initial psychotic episode, during the prodromal period. The phenotype of psychotic symptoms extends to subclinical features in the general population. The traditional medical model assumes a categorical view of the schizophrenia syndrome and its core symptoms, in which differences between psychotic symptoms and their normal counterparts are considered to be qualitative. An alternative, dimensional approach assumes that schizophrenia is not a discrete illness entity, but that psychotic symptoms differ in quantitative ways from normal experiences and behaviours. The causes of and pathways to clinical psychotic disorder can be studied long before the disorder becomes clinically relevant. Delusional or hallucinatory experiences are much more frequent in subjects from the general population than the prevalence of cases of psychotic disorders, thereby suggesting the existence of a symptomatic continuum between subjects from the general population and clinical cases of psychosis. The ultra-high risk or prodromal state is an undifferentiated mix of clinical features, which may include subthreshold or even intermittent suprathreshold psychotic symptoms. Psychological and psychosocial interventions, either alone or in combination with pharmacotherapy, may be effective in at least delaying, if not preventing, the onset of a psychotic disorder. Some highly significant predictors of psychosis were found. It may be justifiable to target these individuals for intensive monitoring of mental state and even low-dose neuroleptic medication or other biological and psychosocial treatments depending on clinical condition. All this adds up to an approach that is called the ‘clinical staging model.’ That is, less-differentiated, early phases of psychiatric disorders benefit from broad-spectrum, simpler treatments. Subthreshold disorders ? syndromes that do not meet the threshold for formal diagnostic entities ? are associated with suffering, impairment, and disability; yet they are not classified by psychiatry’s formal diagnostic systems. The field of schizophrenia research is alive with interest in the clues that early detection and treatment may hold for prevention of this disorder.