*Schizophrenia: Early Recognition and Prevention DOI: http://dx.doi.org/10.5772/intechopen.88537*

*Neurodevelopment and Neurodevelopmental Disorder*

several times a week within the last 3 months.

based on the APS and BLIPS criteria [51].

catatonic behaviour" [1].

education or work-related difficulties.

further progression of the illness [54].

**17. Early intervention and prevention**

ity is also an important treatment goal [1].

disorder and/or pre- or perinatal complications".

• The absence of attenuated or transient psychotic symptoms [1].

odd thinking or speech; suspiciousness or paranoid ideation".

The LIPS criterion attempts to identify those at more immediate risk and is

• The presence of at least one of the following attenuated positive symptoms (APS) present within the last 3 months, appearing several times per week for a period of at least 1 week, but no longer in the same severity than 1 year: "ideas of reference; odd beliefs or magical thinking; unusual perceptual experiences;

• "Brief limited intermittent psychotic symptoms (BLIPS), defined as appearance of one of the following frank psychotic symptoms for less than 1 week (interval between episodes at least 1 week) and resolving spontaneously: hallucinations; delusions; formal thought disorder; gross disorganized or

This two-stage prodromal state guides the treatment approach, that is, psychological or pharmacological therapy [51–53]. LIPS criteria denote an imminent risk of transition to psychotic disorder within the next 12 months, so an antipsychotic medication—second generation—appeared justified. Psychological interventions were crisis intervention, psychoeducation, family counseling, and assistance with

In EIPS group the psychological intervention (cognitive behavioral therapy (CBT) or the supportive control condition) appeared successful in preventing

Early intervention may be able to delay or even prevent onset of psychosis in the UHR or prodromal stage. Both antipsychotic medication (risperidone 1–2 mg/day, olanzapine 5–15 mg/day) and psychological interventions (cognitive behavioral therapy (CBT), case management, supportive therapy, problem-solving strategies) might have a role in treating the difficulties and problems that UHR young people experience, as well as in reducing the rate of transition to psychosis and in reducing symptomatology. Deterioration in psychosocial functioning and persistent disabil-

Therapeutic strategies must be personalized and correlated with the first psychotic episode stages. Treatment for young people who meet ARMS criteria should

The onset of the symptoms has occurred at least a year ago, with a frequency of

• Decrease in "the Global Assessment Functioning Score" (DSM-V) of at least 30 points in the past year which add one of the following risk factors: "first-degree relative with a lifetime diagnosis of schizophrenia or a schizophrenia spectrum

**16.2 Derealization**

**16.3 The LIPS criteria**

**42**

not only focus on the symptoms that constitute the ARMS criteria but also address the range of difficulties which the young person might present.

Side effects associated with all antipsychotic medications are weight gain, diabetes, and sexual dysfunction for olanzapine [55–57] and sexual dysfunction and insomnia for risperidone [1]. Extrapyramidal side effects such as tardive dyskinesia, which is often irreversible, are less common with the newer, atypical antipsychotics [58, 59]. Evidence also suggests that certain antipsychotics (haloperidol) reduced gray matter volume in the brains of patients with a first episode of psychosis [60]. In contrast the newer second-generation antipsychotic medications, in fact, have neuroprotective qualities.

Antipsychotic drugs are potentially useful in the latter phases of the prodromal period when attenuated psychotic symptoms are evident and the individual is on the edge of a conversion to full psychosis.

Psychological interventions are useful in earlier and less symptomatic stages of the prodrome, to manage the stress, depression, anxiety, sleep disturbance, and decline in functioning. CBT should be effective for people with attenuated psychotic symptoms or with brief limited intermittent psychotic symptoms and for individuals who are "false positives" [22].

Psychological treatments may be not only necessary but sufficient for some of these putatively prodromal patients [1].

Further researches are required to determine which treatment strategies are most effective and how long they should be continued.

Ethical considerations associated with treatment of young people who meet ARMS criteria have been widely debated [17, 28, 40, 41, 42, 45, 46]. Concerns about stigma associated with being identified as having a label of ARMS "false positives" and for how long should treatment be provided (in other words, how long is the period of risk) remain unresolved, and even clinical research into ARMS has now been conducted for over a decade.

*Neurodevelopment and Neurodevelopmental Disorder*
