| Vol 7 n° 1 - Early stages of schizophrenia |
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Keywords: prodrome; treatment; psychosis; prevention; early identification;
schizophrenia
Author affiliations: The Zucker Hillside Hospital, North Shore-Long Island Jewish
Health System, Lake Success, NY (Barbara A. Cornblatt); Albert Einstein College
of Medicine, New York, NY, USA (Barbara A. Cornblatt, Andrea M. Auther)
Address
for correspondence: Dr Barbara A. Cornblatt, The
RAP Program, 444
Lakeville
Road, Suite 303, Lake Success, NY 11042, USA
(e-mail:
cornblat@lij.edu)
decade ago, the schizophrenia prevention
movement was launched with great expectations.At that
time, a handful of treatment studies began, founded more
on enthusiasm, intuition, and indirect findings than on a
solid base of evidence. Today, though still in its infancy,
the field thrives. Early intervention programs have dra-
matically proliferated around the world, and the data,
though still sparse, are nonetheless quite encouraging.
The target of these studies is the schizophrenia “pro-
drome,” which refers to the phase of illness that precedes
the onset of psychosis. Treatment, to date, has been
largely pharmacological, although at least one major psy-
chotherapy trial has now begun in the United Kingdom.1
In this paper, we will review the treatment findings cur-
rently available that address the following basic issues:
(i) what should be treated; (ii) when should treatment be
initiated; and (iii) how long should treatment last. First,
we begin with why: why begin treatment prior to psy-
chosis, the stage of illness that defines schizophrenia?
Why treat the prodromal phase
of schizophrenia?
Initially,the prevention movement gained early momentum
from the convergence of two, very separate, research tradi-
tions.The first of these established the neurodevelopmen-
tal view of schizophrenia, now widely accepted throughout
the field.This model provides the logic of early interven-
tion.The second tradition is far more empirical,and is based
on increasing evidence that early treatment, initiated as
close after onset of psychosis as possible, appears to
improve outcome. It thus follows from these findings that
treatment started before onset might be better still.
3 9
P h a r m a c o l o g i c a l
a s p e c t s
A
Copyright © 2005 LLS SAS. All rights reserved
www.dialogues-cns.org
Treating
early psychosis:
who, what, and
when?
Barbara
A. Cornblatt, PhD, MBA; Andrea M. Auther, PhD
Early intervention and prevention in schizophrenia is just
over 10 years old. The assumption guiding this field is that
intervention is likely to be most effective if it begins
before psychosis sets in, ie, during the prodromal phase.
Although a substantial number of prodromal treatment
programs have been initiated around the world, three
early programs have generated most of the intervention
findings to date: Personal Assessment and Crisis Evaluation
(PACE) in Australia, and the Prevention through Risk
Identification, Management, and Education (PRIME) and
Recognition and Prevention (RAP) programs in the USA.
The data suggest that early intervention leads to a reduc-
tion in prodromal symptoms and clinical distress. However,
prevention of psychosis remains an unresolved question.
Other issues include defining who should be treated, with
what, and when. In addition, treatment targets associated
with functional disability, such as early prodromal nega-
tive symptoms and risk factors, continue to emerge. Newly
identified targets, in turn, suggest the need for a variety
of novel interventions and treatment strategies.
© 2005, LLS SAS
Dialogues
Clin Neurosci. 2005;7:39-49.
