**13. Duration of prodrome**

Regarding the duration of the prodrome, retrospective studies suggest a variation ranging from a short period to several years [7, 26, 28].

**39**

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

**14. Genetic risk programs for psychosis**

The development of genetic high-risk (GHR) programs was an important step

The phenotype "schizophrenia" has been characterized by the presence of behavioral abnormalities, the related outcome, and its longitudinal course, but not its fundamental biological substrate. The absence of a neuropathological basis for schizophrenia was one reason that some researchers supported the neurodevelopmental hypothesis of schizophrenia issued by Weinberger [33]. Evidence of obstetrical complications being associated with the risk of schizophrenia supported that

In recent years, genetic research have identified specific genes for schizophrenia, some with early phenotypic expression may be considered important biomarkers, for example, the CHRNA7 gene situated on chromosome 15 with importance in

The premorbid risk factors associated with schizophrenia as motor and cognitive

Neuroimaging anomalies found in patients diagnosed with first-episode psychosis have been interpreted as supportive of a static structural abnormality associated

Recently, the association of molecular genetics with intermediate phenotypes such as cognitive impairment or abnormal brain functioning, as measured with functional neuroimaging, has generated diverse understanding of major psychosis. The combination of different levels may be of particular importance for longitudinal "at risk" studies. These studies can identify individuals who are at true risk of developing major psychosis prior to its full clinical expression, enabling us to treat "at risk" individuals prior to full manifestation of psychosis and prevent its appear-

The measurement of genetic profiles using groups of candidate genes in combination with psychosocial risk factors such as stress and illicit drug use in samples of patients with clinically significant but subthreshold features of psychosis and mood disorder is a key strategy in enhancing predictive power for transition to more established and severe psychotic disorders, in treatment selection, and in longer-

Genetic studies suggest that diagnostic boundaries may be modified based on genetic information and some genes such as NRG1, DTNBP1, DISC1, and BDNF may relate to risk for both schizophrenia and mood disorders [37]. The synergistic use of genotyping with phenotypes characterizing brain functioning will contribute to a better understanding of the mechanisms by which genes interact with other

Identification by different methods of people at risk of psychosis in the general population has allowed an increase in accuracy from a rate of 1% to a rate of approximately 30% [1]. However, the increase in accuracy has raised some criticism. One is that the screening would not be effective in the general population because of the lower base rate of psychotic illness in that population [38], so screening for UHR criteria would not be supported at this stage [19]. The second criticism is that there is a high false positive rate in all of these studies, the majority

delay and obstetrical complications are nonspecific; their prevalence in the nonaffected population is important, so their positive predictive value for the develop-

with schizophrenia that had originated early in neurodevelopment [35].

ance during critical developmental periods such as late adolescence [1, 36].

for early detection and intervention, especially in schizophrenia.

genetic transmission and heredity of schizophrenia [29–32].

developmental abnormalities were involved [34].

ment of schizophrenia is limited.

term prognosis [1].

genes and/or environmental risk factors.

**15. Disadvantages of "prodromal" identification**

*Neurodevelopment and Neurodevelopmental Disorder*

frequency, duration, and recency) could be assessed [1, 24].

• Neurotic symptoms: anxiety, irritability, restlessness.

Symptoms associated with prodromal phase.

prodromal phase:

oscillations.

disorders.

behavior, functional deterioration.

**12. Risk factors to developing psychosis**

**13. Duration of prodrome**

anhedonia, withdrawal, functional deterioration [27].

tion ranging from a short period to several years [7, 26, 28].

other settings around the world (USA, UK, Norway, Germany, etc.).

The intensity of psychotic symptoms characteristic for each of the UHR groups was firstly assessed using the following scales: the "Brief Psychiatric Rating Scale (BPRS) and the Comprehensive Assessment of Symptoms and History (CASH) interview." To specify the frequency and duration of psychotic symptoms, new criteria were needed. So, a new instrument, the Comprehensive Assessment of At Risk Mental States (CAARMS) was designed so that all relevant domains (intensity,

The PACE UHR criteria have been adopted and adapted in a large number of

• Affective symptoms: depression, anhedonia, guilt, suicidal ideas, thymic

• Volitional disturbances: apathy, loss of interest, low energy, fatigue.

Yung and McGorry [16] identified eight subtypes of symptoms characteristic of

• Cognitive deficits: attention deficit, rumination, abstraction difficulties, thought blockages, thought interference, thought perseveration, thought pressure.

• Psychotic symptoms: visual and auditory perceptual disturbances, suspicious-

• Physical symptoms: somatic symptoms, weight loss, low appetite, sleeping

• Behavioral dysfunctions: social withdrawal, impulsivity, aggressivity, bizarre

• Other symptoms: sensitivity, odd beliefs or magical thinking, dissociation.

Yung and collaborators [19, 25] have elaborated a set of operational criteria to identify individuals at risk for developing a psychotic disorder over the next 6–24 months as Global Assessment of Functioning (GAF) scale score <51, BPRS score >2, and Hamilton Depression Rating Scale (HRDS) score >18 [19, 25].

During the years, several research teams have identified a number of risk factors for the development of psychosis: Carr and collaborators (2000): family history, perinatal complications, premorbid personality, stressful life events; Mason et al. [26]: schizotypal personality disorder, hallucinations, magic thinking, odd beliefs,

Regarding the duration of the prodrome, retrospective studies suggest a varia-

ness or paranoid ideation, derealization, unstable ideas of reference.

**38**
