The New York high risk project to the Hillside recognition and prevention (RAP) program.
The sudden interest in initiating treatment before the onset of psychosis (i.e., during the prodromal stage of schizophrenia) has failed to integrate the earlier work on prediction generated by more traditional high-risk studies. Genetic high-risk research has most typically focused on the long-term, prospective study of children of parents with schizophrenia. In this paper, it will be argued that high-risk research can make at least two major contributions to prevention programs. First, previous findings can guide identification of risk factors and provide clues about causality, thus highlighting which pre-morbid deficits should be treatment targets. For example, as discussed here, data from the New York High Risk Project points to impaired attention as a highly promising candidate risk factor, with a possible causal association with later-emerging social deficits. Second, the high-risk approach can provide a framework for establishing the predictive validity of prodromal clinical indicators and for understanding the nature of the schizophrenia prodrome. Preliminary findings from the Hillside Recognition and Prevention (RAP) program, integrating high-risk methodology with an early intervention strategy, indicate that the prodrome is a developmentally complex phase of schizophrenia. In particular, a cluster of early features-including cognitive, academic, and social impairments, along with odd/disorganized behaviors-appear to anticipate positive symptoms and may constitute a core risk profile. Preliminary RAP treatment findings also suggest that medications other than anti-psychotics may be effective for treating early prodromal symptoms, challenging the widely held hypothesis that anti-psychotics should always be the first line preventive treatment.
Cornblatt
Barbara A
BA
Department of Psychiatry Research, Hillside Hospital of the North Shore-Long Island Jewish Health System, Glen Oaks, New York 11004, USA. cornblat@lij.edu
D006801:Humans; D009518:New York; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control*