Background: The onset of psychosis is mostly preceded by a prodromal phase in which occur a series of various attenuated positive symptoms, negative symptoms and functional impairment. Recently, several longitudinal studies have evaluated the validity and prediction power of the "prodromal risk syndrome for psychosis", which could lead to a better focused management of the patients at real risk of developing schizophrenia. At the same time, several authors have studied the pharmacological and non-pharmacological interventions for people at ultrahigh risk.
Methods and aims: The objective of this review is to establish the status of our current knowledge about what is the most sensitive and specific tool to predict high risk of psychosis in the young population and which treatments have currently proved to be the most effective in the risk versus benefits balance. We will try to answer to these questions by reviewing the international literature from 2005 until today.
Results: Recent studies show significant improvement in the identification of individuals at high risk of developing psychosis, using validated detection scales such as SIPS and CAARMS, multivariate neuroanatomical pattern classification and specific genetic factors. Cognitive Behavioral therapy, approach improving social functioning, and Long-Chain Ω-3 Fatty Acids appears to be promising alternatives to antipsychotics, for which the balance between benefice and adverse side effects seems questionable.
Conclusions: Detection of young people at ultrahigh risk of psychosis has significantly improved during the last 6 years. The challenge for the next decade will be to define a nosologic entity specific and sensitive enough to become a diagnostic category by itself, which could lead to specific guidelines for the preventive management of psychosis.