Commentary: Progress, issues, and implications of prodromal research: an inside view

This issue of the Schizophrenia Bulletin focuses around research in the prodromal phase of severe mental illness, largely schizophrenia. The years since the last Bulletin issue on early detection and intervention have witnessed success at identifying the prodrome prospectively, positive initial data about treating prodromal symptoms and delaying psychosis onset, and hopeful data about elucidating the pathophysiology of psychosis through the prodrome. In this overview I will comment on some of the opportunities and challenges generated by this new line of research. Themes include the recruitment of prodromal subjects, characteristics of prodromal samples thus far collected, the process of conversion to psychosis in these samples, minimizing false positive prodromal subjects, dosing of drug treatments in prodromal clinical trials, treatment practice implications of prodromal research, defining conversion to psychosis prospectively, and screening, assessing, and naming the prodrome. It is concluded that prodromal research holds much promise but will require the formal collaboration of many investigators and the availability of resources for sustained efforts to recruit what amounts to an incidence sample.