[Diagnosis and treatment of mental states at high risk for psychosis]

Despite the fact that the need for and possibility of diagnosing and treating schizophrenia in the prodromal phase is as old as the disease category itself. the first controlled studies were published only in the last 15 years. Using structured interviews and rating scales, the development/first episode of psychosis can be forecast only with a modest specificity: 30-60% of the persons with prodromal symptoms based on operationalised criteria develop full-blown psychosis during a 12-month follow-up period. A 6-month, low-dose antipsychotic treatment combined with psychotherapy can reduce this risk of psychosis by 50-60%. The treatment based on the clinical picture can be supplemented with antidepressants and anxiolytics. Despite the successful prevention, patients continue to show considerable residual symptoms and decreased coping abilities. Long-term effects of intervention, false positive cases, and stigmatization are among the most problematic, unresolved issues. According to international results and our own experience, psychosis prevention is currently adequate only in the case of help-seeking patients if the operationalised criteria of the prodrome are present. Detailed patient education and the ensuing informed consent are indispensable. Biological relatives of schizophrenia patients should be assessed with special care. Persons at increased risk of psychosis should be offered long-term follow-up and care and an "open doors" policy in the case of worsening symptoms and crisis.