Indicated prevention of schizophrenia.
BACKGROUND
Despite recent advances in their treatment, schizophrenic disorders are still among the diseases that most severely impair patients' quality of life. For this reason, centers for the early recognition of schizophrenic disorders have come into existence worldwide. In these centers, much effort is devoted to the development and testing of suitable preventive strategies.


METHODS
In this article, we selectively review the literature on the currently available means of assessing the individual risk of becoming ill with schizophrenia and of preventing the imminent onset of the disease.


RESULTS
The currently recognized neurobiological and psychosocial risk factors are not predictive enough to enable the development and application of selective prevention measures for asymptomatic persons at risk. The imminent onset of schizophrenia can be predicted with high accuracy, however, in cases where an initially non-psychotic patient develops early cognitive symptoms that imply a risk of schizophrenia and then, later on in the prodrome of the disease (which typically lasts about five years), goes on to develop high-risk symptoms with mild psychosis. At this point, a differential strategy of indicated prevention can be put into action, including cognitive behavioral therapy, atypical antipsychotics in low doses, and neuroprotective agents.


CONCLUSIONS
The current state of knowledge in this innovative field of research leads us to expect that it will soon be possible to offer individually tailored preventive measures to persons seeking medical help and advice because of the early warning signs of schizophrenia.
Klosterkötter
Joachim
J
Klinik für Psychiatrie und Psychotherapie, Universität zu Köln, Kerpener Strasse 62, Köln, Germany. joachim.klosterkoetter@uk-koeln.de