Prediction and prevention of the first psychotic episode: new directions and opportunities

Sara Piras, Gianluca Casu, Maria Antonietta Casu, Alessandro Orrù, Stefania Ruiu, Antonio Pilleri, Gabriella Manca, Giorgio MarcheseNational Research Council, Institute of Translational Pharmacology, Strategic Operating Unit of Cagliari, Cagliari, ItalyAbstract: In the last few decades, substantial research has focused on the possibility of early detection and prevention of the first psychotic episode in young individuals at risk of developing this mental disturbance; however, unresolved clinical and ethical issues still call for further investigations. New perspectives and opportunities may come from the identification of selective psychopathological and instrumental markers linking the appearance of subtle psychotic symptoms with the clinical outcome of specific mental pathologies. Furthermore, empirically derived algorithms and risk staging models should facilitate the identification of targeted prevention therapies, possibly improving the efficacy of well-tolerated therapeutic approaches, such as psychological interventions and natural compound supplementations. To date, the collected evidence on the efficacy and tolerability of pharmacological prevention therapies raises more doubts than hopes. A very early detection of risk and appropriate symptomatic pattern classifications may provide a chance to better match prevention strategies with the development of psychosis.Keywords: psychosis, risk, basic symptoms, schizophrenia, therapy