Early intervention in patients at ultra high risk of psychosis: benefits and risks.
OBJECTIVE
Prediction of transition to psychosis in the prodromal phase of schizophrenia has raised interest in intervention prior to the onset of frank psychosis. The aim of this review was to examine whether interventions in the prodromal phase have a favourable benefit/risk ratio.


METHODS
A literature search in PubMed, EMBASE and PsycINFO was performed.


RESULTS
Three randomized clinical trials with antipsychotic medication and/or cognitive behavioural therapy as clinical intervention suggested a positive effect at the end of treatment, but no significant differences were found at the end of follow-up periods from 1 to 4 years. Naturalistic studies present a hypothesis about a possible preventive effect of antidepressive medication. The results of eight other studies are more difficult to interpret. Side-effects of antipsychotic medication and non-adherence with medication are essential problems.


CONCLUSIONS
At the present time, the data concerning the benefits and risks do not justify prodromal intervention as standard clinical practice.
de Koning
M B
MB
Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands. m.b.dekoning@amc.uva.nl
Bloemen
O J N
OJ
van Amelsvoort
T A M J
TA
Becker
H E
HE
Nieman
D H
DH
van der Gaag
M
M
Linszen
D H
DH
D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D017063:Outcome Assessment, Health Care; D011618:Psychotic Disorders / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D018570:Risk Assessment; D012559:Schizophrenia / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D012565:Schizophrenic Psychology; D016896:Treatment Outcome
D000928:Antidepressive Agents; D014150:Antipsychotic Agents