“Very early schizophrenia still constitutes a relatively unexplored territory. Entry into this territory calls for new ideas on the social problems involved in bringing the early schizophrenic promptly under treatment, or where the treatment should be carried out and in what it should consist.” D. Ewen Cameron (1938)

Background The primary rationale for early detection and intervention in schizophrenia is the disorder's severity, chronicity and treatment resistance. This suggests that researchers pay closer attention to schizophrenia's premorbid and onset phases, when the vulnerability to psychosis becomes expressed and the neurobiological deficit processes driving symptom formation appear to be the most active.

Method We review the evidence that brain plasticity may be retained or reversed despite deficit processes.

Results The data are preliminary but suggestive enough to warrant further research.

Conclusions Overall, we need to focus on the early course of schizophrenia, detecting cases early at onset or in the prodrome, testing whether this enhances treatment response and prognosis, and predicting at-risk cases early in the prodromal phase. Designs to address these questions are presented, and relevant issues are discussed.

The DSM–IV operational diagnostic criteria for schizophrenia (American Psychiatric Association, 1994) are being used extensively in several countries for clinical, research and educational purposes.

Background The current study examines teacher ratings as a tool for identifying students at risk of developing psychosis. Follow-up and follow-back studies have shown that teachers are capable of identifying individuals who later develop serious mental illness.

Method We examine the long-term outcomes for individuals at genetic risk who were identified as showing markedly deviant behaviour and those identified who did not show markedly deviant behaviour.

Results Teachers were able to correctly anticipate 35% of students who developed schizophrenia. Furthermore, those identified as showing markedly deviant behaviour had poorer clinical and psychiatric outcomes 10 and 25 years later than those identified as not behaving with marked deviance. Their ratings also differentiated, within the group of people with schizophrenia, which individuals would show evidence of poorer functioning 25 years later. These results were replicated in a group of students not at genetic risk of schizophrenia. Within this low-risk group, teachers were able to predict which students would develop psychotic disorders.

Conclusions Teacher ratings were particularly useful in predicting clinical and psychiatric outcomes 10 and 25 years later. The applicability of these findings in early intervention and treatment research is discussed.