Prediction of psychosis: setting the stage

Treating psychotic disorders in their earliest stages has become a key focus for research and clinical care. This paper reviews evidence of the capacity to identify those at increased risk for psychotic disorder and to intervene in the identified, high-risk individuals to ameliorate the course of disorder. Issues involved in preventive oriented clinical care are addressed, such as risk/benefit considerations, ethical and safety issues and the value of stage-specific interventions. Clinical predictors identified in recent research, promising intervention trials and proposed clinical practice guidelines are described. An approach based on active engagement, support and monitoring, yet with a conservative approach to medication use is advocated at present. Potential neurobiological processes have been studied and reinforce the sense that this is a critical phase for active treatment, and may prove helpful in understanding the process of transition across stages of illness. More research is required in prediction, neurobiology and treatment.