ABSTRACT
The last decade has seen the beginning and subsequent burgeoning of ‘prodromal’ or ‘pre-psychotic’ research in schizophrenia and related disorders. The idea was originally formulated and trialed in a population-based manner by Falloon, with a project that encouraged general practitioners in and around the English towns of Buckingham and Winslow to refer patients suspected of having a’schizophrenic prodrome’ to a mental health service for treatment. A reduction in incidence of first episode schizophrenia compared to historical figures was found and cited as possible evidence for the effectiveness of such targeted preventive intervention (Falloon et al 1990; Falloon 1992; Falloon 2000). Falloon acknowledged methodological difficulties with this approach and the fact that some people not actually at risk of schizophrenia would have been unnecessarily labelled and treated. However, this study opened the way for early intervention strategies in psychosis to consider the prodromal phase as a potential focus for treatment. The strategy has largely shifted now to the targeted approach that has been described in earlier chapters. This chapter presents some of the research to date from the PACE Clinic and other centres around the world. Broadly speaking, four areas of investigation have been conducted:
1 Validation of ultra high risk (UHR) criteria. 2 Investigations into the onset of disorder and factors that increase the likelihood of
progression from ‘at risk mental state’ (ARMS) to psychosis. 3 Investigations into the neurobiology of psychotic disorders, especially the neurobiology
of emerging psychosis. 4 The development, application and evaluation of interventions aimed at prevention,
delay or amelioration of the onset of the first episode of psychosis.
