Intervention in the at-risk state to prevent transition to psychosis

The number of intervention studies aiming to prevent psychosis is still small. Follow-up data of the first studies were published during the last year and neuroprotection has become an important issue.

Initially superior effects of pharmacological or cognitive intervention reported by the first studies in the field became less clear about 3 years after cessation of intervention; however, a common problem of these first trials is a small sample size resulting in a lack of sufficient statistical power. The first studies of interventions thought to act as primarily neuroprotective yielded promising findings; however, further studies are needed to evaluate the preventive as well as the neuroprotective efficacy of these approaches.

Besides methodologically sound studies, improved enrichment strategies are required as well as risk-adapted intervention strategies, guided by evidence-based clinical staging algorithms. Furthermore, the current concept of psychosis prevention, requiring an intervention to show long-lasting effects even after cessation, needs reconsideration. Approaches as used for relapse prevention in psychosis or for chronic at-risk states in internal medicine may help to maintain the initial superior prophylactic effects.