Pharmacological intervention in the initial prodromal phase of psychosis

Abstract

Early identification and treatment of schizophrenia may alleviate the symptoms, delay the onset and improve the outcome of psychosis. Thus, detection of individuals at risk during the prodromal phase is an important task. Universal approaches to screen the general population or healthy subjects at risk have not proven possible to-date. However, clinical criteria for detecting ultra-high risk individuals have been developed for specialized settings, with their implementation in interventional studies. This article examines the rationale for early detection and intervention of psychosis, along with a review of some of the current studies. These target prevention using psychological and/or pharmacological intervention strategies have demonstrated promising results in high risk individuals. The German Research Network on Schizophrenia (GRNS) is conducting two multicenter early intervention studies; one with early psychological intervention in subjects who manifest early prodromal symptoms; with the second trial applying clinical management and pharmacological early intervention in subjects experiencing late prodromal symptoms (high risk subjects). Despite the promising results, many of the current studies have small sample sizes with study durations of a short period. The full benefits of early detection and intervention should be revealed once larger and longer studies are conducted.

Abnormal P300 in people with high risk of developing psychosis

“…The basis of the vulnerability to psychosis in this group is unknown and, whilst evidence shows that psychological and pharmacological interventions improve outcomes (Bechdolf et al, 2005;McGorry et al, 2002;Miller et al, 2003;Phillips et al, 2005;Ruhrmann et al, 2005;Woods et al, 2003), treating high risk subjects remains controversial since most of them are not destined to develop the disease (Broome et al, 2005b;Cornblatt et al, 2001;Haroun et al, 2006). The identification of biological measures associated with a subsequent transition to psychosis would help to target early treatment to those who require it (Bender et al, 2007;Eastvold et al, 2007;Mason et al, 2004;Pantelis et al, 2003;Simon et al, 2007;van der Stelt and Belger, 2007).…”

Early Psychosis: Where we've been, where we still have to go

“…While many people attending pre-onset clinics are not experiencing a current psychotic episode, this does not necessarily mean that they are not experiencing any mental illness. Often they may be experiencing either sub-threshold or diagnosable symptoms of affective or anxiety problems (Rosen et al, 2006;Ruhrmann et al, 2005;Svirskis et al, 2005;Yung et al, 2004). Whether these syndromes are precursors to a psychotic episode or not, they warrant treatment.…”

174.2 Psychosis Prediction: Stratification of Risk Estimation With Information-Processing and Premorbid Functioning Variables

“…1,2 Ultrahigh risk (UHR) criteria have been defined to prospectively identify people in this prodromal phase. [3][4][5][6] In a recent meta-analysis, 7 the average 1-year transition rate to first episode psychosis in UHR subjects was 21.7%, increasing to 31.5% after 3 years of follow-up.…”

“…20 In the Dutch Prediction of Psychosis Study (DUPS), subjects clinically at high risk (CHR) were assessed with a comprehensive assessment battery covering 5 domains (neuropsychology, psychopathology, social and role functioning, environmental factors and premorbid adjustment, and neurophysiology) and were followed up for 3 years. 21 Transition to first episode psychosis was found to be significantly associated with (table 1) (1) reduced semantic verbal fluency, 22 (2) increased social anhedonia and withdrawal, 23 (3) urbanicity, 24 (4) poor premorbid adjustment, 24 and (5) reduced amplitude of the midline parietal (Pz) P300 event-related potential (ERP) 25 (figure 1). The P300 is a cognition related wave, closely associated with attention and memory and a reduced P300 amplitude is one of the most reported potential biomarkers of schizophrenia.…”