CLINICAL HANDBOOK OF SCHIZOPHRENIA

388 VI. SPECIAL POPULATIONS AND PROBLEMSseen in early psychosis. Neuroprotective strategies counteracting the loss or supportingthe generation of progenitor cells may therefore be a therapeutic avenue to explore. Candidatetherapies include lithium, eicosapentanoic acid (EPA), and glycine. Studies usinglithium, glycine, and EPA are currently underway at the PACE and PRIME Clinics.Other pharmacological interventions may also be indicated in the UHR group, dependingon the young person’s presentation and current problems. For instance, specifictreatment for syndromes such as depression and anxiety may include medication.RECOMMENDATIONS AND FUTURE DIRECTIONSThis chapter has provided a brief overview of the identification of the high-risk populationand the current approach to its psychological and pharmacological treatment, withan emphasis on the approach used at the PACE Clinic. This area, still in its infancy, thereforerequires constant evaluation. Although there is some evidence for the efficacy of thetreatments we have reviewed, ongoing research will provide a clearer indication of themost effective types of psychological and pharmacological interventions, and suggest avenuesfor refining these interventions. Intervention research with this population shouldcontinue in the context of methodologically sound and ethical clinical trials. Larger samplesizes, with a higher proportion of “true positive”cases are required to increase validityof the findings.Due to the early stage of research in this field, researchers need to keep an open mindabout possible treatments and to be responsive to developments in related areas of research,including the treatment of established psychosis. In addition to intervention research, it isalso necessary to continue attempts to determine the most potent psychopathological,neurocognitive, neurological, and biological vulnerability markers, and combinationsthereof, for transition from an at-risk mental state to full psychosis. This will not only assistin increasing the accurate identification of truly prodromal individuals (i.e., minimize“false positives”) but also guide the refinement of treatment interventions.KEY POINTS• The prodromal phase of psychotic disorder presents two possible targets for intervention:(1) current symptoms, behavior, or disability, and (2) prevention of further decline into frankpsychotic disorder.• The prodrome is a retrospective concept; the term at-risk mental state (ARMS) has been introducedto refer to the phase prospectively identified as the possible precursor to full-blownpsychosis.• The PACE Clinic introduced a “close-in” strategy to identifying the ARMS population, usinga combination of trait and state risk factors.• The treatment approach adopted by the PACE Clinic has comprised general treatmentmeasures and both psychological (supportive psychotherapy and cognitively oriented psychotherapy)and pharmacological treatments.• General treatment measures include information giving, case management, crisis management,and family interventions.• Cognitively oriented psychotherapy is informed by the stress–vulnerability model of psychosisand comprises four treatment modules: Stress Management, Depression/NegativeSymptoms, Positive Symptoms, and Other Comorbidity.• Intervention trials with antipsychotic medication indicate that rate of transition to psychosismay be reduced in medication-adherent individuals.