The schizophrenia prodrome: promise for prevention

Converging theoretical, psychopharmacological, neurodevelopmental advances have led to increasing interest in preventive intervention in schizophrenia. In particular, evidence suggests that early treatment is associated with a better prognosis. Furthermore, based on the reported reduction in severe side effects, the new novel antipsychotics potentially provide the tools for early intervention. Nevertheless, initiation of intervention during the prodrome has become controversial because of such unresolved issues as: (i) how to accurately identify susceptible individuals who are in true need of preventive intervention; (ii) at what developmental point in the prodrome medication should be initiated; (iii) how long medication should be continued; and (iv) what medication is optimal for each phase of the prodrome. By adopting a naturalistic, prospective research strategy, the Recognition and Prevention (RAP) program now underway in New York has been designed to address these and other important questions involved in prodromal research and treatment.