Diagnosis and treatment of prepsychotic conditions

Abstract

Prevention of mental ill health has been declared a major task by the European Commission; and an early detection and intervention in psychosis in terms of an indicated (secondary) prevention in persons already seeking help for mental problems is increasingly approached across Europe both on research as well as clinical level, a mixture of both dominating. The growing interest in this field of research across Western and Western-Central Europe becomes apparent in the rapidly increasing number of publications on this topic since the turn of the century that has nearly increased by the factor of 5. The 3 leading European countries in this are Germany, the United Kingdom and Switzerland.

Despite the very well reception of the ‘prevention idea’ by clinicians, researchers, relatives of patients with psychosis and clients and first promising results of early detection and/or early intervention studies, critics caution against the percentage of false-positive predictions by current prodromal criteria and the possibly unnecessary initiation of an antipsychotic psychological and/or pharmacological treatment along with its risks of unwanted side effects including early stigmatization. Supporters, however, argue that these short-comings will be overcome in the course of time and that the potential of new benign preventive interventions was just about to be discovered as well as caution against self-stigmatization by odd, eccentric behaviours and loss of functioning not recognized as part of an illness but attributed to the person him-/herself.

In future, joint efforts across clinical and scientific disciplines as well as countries will be required to enhance predictive accuracy, to develop broadly applicable and risk-adapted interventions, to provide help to all in need, to extend preventive efforts to other psychiatric disorders and to possibly reach the ultimate aim, a primary prevention of mental disorders.