Is pre-psychotic intervention realistic in schizophrenia and related disorders?

Objective: The aim of this paper is to discuss the logistic and ethical questions related to the possibility of intervention prior to the onset of first-episode psychosis (i.e. during the prodromal phase). Method: The method involved examination of the published literature on prevention of psychotic disorders and other mental disorders, and critical evaluation of current practice in treating pre-psychotic individuals. Results: Issues of possibly unnecessary or premature labelling, stigma and treatment arise. The question of whether such early intervention merely diagnoses the disorder earlier but does not actually improve outcome is also discussed, as are the economic implications of shifting emphasis from treatment of established disorders to preventive interventions. Conclusions: There are many legitimate concerns related to intervening in pre-psychotic individuals which must be understood by those involved in planning preventive interventions. Policies should be developed incorporating some of the ethical and economic concerns, and these need to be evaluated and changed in response to ongoing research. However, these issues need not stand in the way of the development of innovative preventive approaches to the treatment of schizophrenia and other psychotic disorders.