**9. False positives and treatment**

However, early attempts at prodromal intervention were hampered, by the problem of "false positives" and their implications for preventive intervention. "False positives" refer to those who are identified as being prodromal, at risk of developing a psychotic disorder in the near future, but who do not do so. Some of these people were in fact never "destined" to develop a psychotic disorder (the "true false positives") [1]. These persons may be harmed by being considered as "prodromal" or "high risk of psychosis" and may receive treatment unnecessarily

**37**

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

**10. Description of prodromal phase**

more of the following groups are met:

and have spontaneously abated.

baseline and follow-up.

during psychosis.

**11. Ultrahigh risk**

[19, 22]

mental ill health.

than 1 week [1, 19].

[17–19]. In contrast are those individuals who would have developed a psychotic disorder were it not for some alteration in their circumstances,such as a treatment intervention, stress reduction or cessation of illicit drug use, that preventing this form occurring [1]. This latter group has been termed "false false positive" [19]. It is virtually impossible to distinguish between these two groups phenotypically at

The conceptualization of the prodrome phase uses two methods: a retrospective/passive method which involves getting information from the patient and his/ her family and a proactive one which includes observation and patient monitoring

Yung and McGorry [16] describe the phenomenology of the prodrome phase, summarizing the data from the literature with those of the Melbourne Personal Assessment and Crisis Evaluation (PACE) approach [20, 21]. The PACE Clinic

The PACE ultrahigh-risk (UHR) criteria require that a young person aged between 14 and 30 is referred for health care to the clinic if the criteria for one or

1.Attenuated psychotic symptom (APS) group has experienced subthreshold,

2.Brief limited intermittent psychotic symptom (BLIPS) group has experienced episodes of frank psychotic symptoms that have not lasted longer than a week

3.Trait and state risk factor group has a first-degree relative with a psychotic disorder or the identified subject with a schizotypal personality disorder and has experienced a significant decrease in functioning during the previous year

The ultrahigh-risk (UHR) criteria allow the recognition of young people at risk of onset of a psychotic disorder (late adolescence/early adulthood) who also report mental state disorder suggesting an emerging psychotic process or who may have a positive family history of psychosis accompanied by evidence of

Necessarily, criteria have also been developed to define the onset of frank psychosis. These are not identical to DSM-V criteria [22, 23] but are elaborated to define the minimal point at which antipsychotic treatment is indicated. This definition is arbitrary but even has a well-defined treatment implication, applicable equally to "substance-related symptoms, symptoms that have a mood component—either depression or mania—and schizophrenia spectrum disorders." The predictive aim is the first-episode psychosis requiring antipsychotic treatment, arbitrarily defined by the persistence of clear psychotic symptoms, more

attenuated positive psychotic symptoms during the past year.

recruits those patients with a perceived need for psychiatric help.

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

*Neurodevelopment and Neurodevelopmental Disorder*

prepsychotic schizophrenia ,to prevent damage".

made between the initial and the relapse prodrome [16].

(Kraepelin, 1896/1987, p. 23).

1908/1987, p. 63).

phases of psychosis.

strategies.

**8. Definition of prodrome**

Other definitions are [16]:

psychosis' onset".

psychotic symptoms".

to frank psychosis may be detectable.

**9. False positives and treatment**

importance to diagnose cases of dementia praecox certainly and at an early stage"

In 1908, Eugen Bleuler, cited by Patrick McGorry in the same book [14], wrote "the sooner the patients can be recovered and the less they are allowed to withdraw in their own world, the sooner they become socially functional" (Bleuler,

Coming from 1927 [15], we find the same idea "I feel certain that many incipient cases might be arrested before the efficient contact with reality is completely suspended, and a long stay in institutions made necessary" ([15], p. 135). Meares in 1950 wrote "it is not necessary to diagnose early schizophrenia but to diagnose

These statements can be used not only as the foundation stones for any therapeutic intervention but also as arguments to emphasize the importance of early

So, the prodrome is a distinct period in the evolution of the first psychotic episode, mostly unknown or minimized as importance. The onset's particularities and the evolution of the first psychotic episode are involved in the short-, medium-, and long-term prognosis. The recovery depends on the early initiation of therapeutic

The prodrome was originally defined as the prepsychotic period preceding a relapse in patients already diagnosed with psychosis. Subsequently a distinction was

• "a heterogenous group of behaviors having a temporal relationship with

• "the period from the first symptoms noted until the onset of prominent

All definitions of prodrome phase have in common the presence of symptoms and the temporal relationship with the onset of psychosis, with two important practical consequences. The first implication is the person being symptomatic during the prodrome will ask for medical help, so it is possible to establish a diagnosis and a therapeutic strategy. The second implication is the person can develop the disease after the end of the prodromal phase, suggesting that the transition from prodrome

However, early attempts at prodromal intervention were hampered, by the problem of "false positives" and their implications for preventive intervention. "False positives" refer to those who are identified as being prodromal, at risk of developing a psychotic disorder in the near future, but who do not do so. Some of these people were in fact never "destined" to develop a psychotic disorder (the "true false positives") [1]. These persons may be harmed by being considered as "prodromal" or "high risk of psychosis" and may receive treatment unnecessarily

**36**

[17–19]. In contrast are those individuals who would have developed a psychotic disorder were it not for some alteration in their circumstances,such as a treatment intervention, stress reduction or cessation of illicit drug use, that preventing this form occurring [1]. This latter group has been termed "false false positive" [19]. It is virtually impossible to distinguish between these two groups phenotypically at baseline and follow-up.
