Abstract
The onset of schizophrenia is usually preceded by a prodromal phase characterized by functional decline and subtle symptoms, which include attenuated psychotic phenomena, cognitive impairments and a decline in socio-occupational function. Research into the early phases of psychosis promises to provide important clues to the mechanisms underlying schizophrenia and psychotic disorders. Investigation of subjects at the beginning of illness allows researchers to minimize confounders such as neurodegenerative progress of disease, institutionalization and long-term treatment, particularly with antipsychotics. In addition, there is evidence indicating that preventative interventions in psychosis are feasible and of great clinical benefits. There are, at least, three possible mechanisms for improving the course of the disease by active interventions before onset of psychosis. First, it might be possible to prevent psychosis by intervening in a crucial phase of beginning symptoms. Second, it might be possible to improve the course of the disease by improving the mental state in the prodromal phase or by postponing the first psychotic episode. Finally, the first psychotic episode might have a more favorable course after intervention in the prodromal phase, because the patient is already enrolled in a mental health treatment program: psychosis will be discovered soon after onset, and the patient might be more willing to accept treatment, thus shortening the duration of untreated psychosis. Interest in this area has grown to the extent that there is an ongoing debate about including a new high risk diagnostic category in DSM-5 (i.e. Attenuated Psychosis Syndrome). We present here a comprehensive issue addressing the core issues in the filed. In the first part of this issue we will focus on the diagnosis of the high risk state for psychosis. We will first review the psychopatholigical available criteria employed to define the prodromal psychotic phases. Then we will address the potential role of neuroimaging techniques such as structural neuroimaging, functional neuroimaging and neurochemical imaging to study core neurobiological markers linked to the pathophysiological mechanisms underlying the pre-psychotic phases. We will thus link the neurobiological findings to neurocognitive and environmental markers of an impending psychosis. In the second part of the issue we will focus on available treatments for people presenting with prodromal signs and symptoms of psychosis including psychopharmacological, psychoeducational and psychotherapeutical interventions. Such active treatments will be presented in the light of the implementation of specialized services devoted to young people presenting with prodromal signs and symptoms of psychosis. Finally we will discuss potential conceptual, ethical and methodological limitations in prodromal psychosis research. The issue largely benefits from leading worldwide authors with a very strong track of publications in the field of pre-psychotic phases and I would greatly thank all of them for their great contributions. Overall I feel this issue will provide a state-of-the-art-review on the diagnosis and treatment of the pre-psychotic phases and I'm sure it will definitely sustain future preventative interventions in psychiatry.
| Original language | English |
|---|---|
| Article number | N/A |
| Pages (from-to) | 337-337 |
| Number of pages | 1 |
| Journal | Current Pharmaceutical Design |
| Volume | 18 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Feb 2012 |