New Targets for Prevention of Schizophrenia: Is It Time for Interventions in the Premorbid Phase?
A number of influences have converged that make this Special Theme Issue timely: "A New Direction: Considering Developmentally Sensitive Targets for Very Early Intervention in Schizophrenia". These factors include: 1. the substantial knowledge about premorbid developmental vulnerabilities to psychosis, especially regarding schizophrenia; 2. the promising results emerging from interventions during the clinical high-risk (CHR) phase of psychosis and; 3. the recognition that the CHR period is a relatively late phase of developmental derailment. These factors have together led to a perspective that even earlier intervention is warranted. This paper briefly summarizes the articles comprising the Special Theme including new data on early neurocognitive development, proposed potential targets for psychosocial and psychopharmacological interventions during the premorbid period as early as pregnancy, and ethical challenges. These thought experiments must be empirically tested, and the ethical challenges overcome as posed by the various interventions, which range from relatively low risk, supportive, psychosocial to higher risk, experimental, pharmacological interventions. All of the interventions proposed require careful study of ethics, safety, potential stigma, feasibility, efficacy and tolerability, and the meaning to the people involved.
Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA; lseidman@bidmc.harvard.edu.
Larry J
LJ
Seidman
Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; The Mental Health Services in the Capital Region of Denmark, Mental Health Center of Copenhagen, Copenhagen, Denmark.
Merete
M
Nordentoft
D061345:Early Medical Intervention; D006801:Humans; D062706:Prodromal Symptoms; D011618:Psychotic Disorders / Q000517:prevention & control*; D012306:Risk; D012559:Schizophrenia / Q000517:prevention & control*
clinical high risk; critical period; early intervention; endophenotype; family high risk; perinatal; premorbid; prenatal; primary prevention; prodrome