© 2003 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
Transition to Schizophrenia and Related Disorders: Toward a Taxonomy of Risk
Professor of Psychiatry and Head of the Department of Psychiatry, University of Bonn Germany
Professor of Psychiatry, Albert Einstein College of Medicine Bronx, NY, Senior Research Scientist and Psychologist, The Zucker Hillside Hospital Glen Oaks, NY, and Director of the Recognition and Prevention (RAP) Program, The Zucker Hillside Hospital and Schneider Children's Hospital Lake Success, NY
Chief of the Section on Developmental Genetic Epidemiology in the Mood and Anxiety Disorders Program at NIMH, Bethesda, and the Associate Director for Epidemiology Policy at the NIMH
Send reprint requests to Prof. Dr. W. Maier, Department of Psychiatry, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany; e-mail: Wolfgang.Maier{at}ukb.uni-bonn.de
The early detection and prevention of schizophrenia and other psychotic disorders are receiving rapidly growing attention subsequent to the suggestion that poorer outcome is associated with delayed onset of treatment among patients in their first psychotic episode. Although the first generation of so-called "prodromal" research programs has produced encouraging preliminary results, more information is necessary on the conversion rates from prodromal states to schizophrenia in specific samples. Early recognition and prevention strategies require a new taxonomy that classifies subjects by their status of risk of imminent onset of psychosis. Without additional knowledge of the mechanisms through which particular constellations of vulnerability factors, precursors, and prodromal symptoms predict the onset of schizophrenia, it is difficult to judge the effects of existing programs. In this paper, we discuss three sets of issues that will need to be resolved before these preventive programs can be implemented into routine care: (1) optimization of predicting the onset of psychotic disorders; (2) development and evaluation of alternative treatment strategies depending on the presenting risk status; and (3) evaluation of costs and benefits of identifying subjects at risk of psychosis/schizophrenia and receiving a specific preventive treatment.
Keywords: Schizophrenia / vulnerability factors / prodromal symptoms / early recognition / early prevention / treatment strategies
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