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

Curr Opin Psychiatry. 2009 Mar;22(2):177-83. doi: 10.1097/YCO.0b013e328324b687.

Abstract

Purpose of review: 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.

Recent findings: 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.

Summary: 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.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Antipsychotic Agents / therapeutic use*
  • Child
  • Cognitive Behavioral Therapy*
  • Combined Modality Therapy
  • Early Diagnosis
  • Follow-Up Studies
  • Humans
  • Neuroprotective Agents / therapeutic use*
  • Psychotic Disorders / diagnosis
  • Psychotic Disorders / prevention & control*
  • Psychotic Disorders / psychology
  • Randomized Controlled Trials as Topic
  • Schizophrenia / prevention & control*
  • Schizotypal Personality Disorder / diagnosis
  • Schizotypal Personality Disorder / psychology
  • Schizotypal Personality Disorder / therapy*
  • Young Adult

Substances

  • Antipsychotic Agents
  • Neuroprotective Agents