Abstract
This review aims to describe the importance of i) detecting individuals at clinical
high-risk for psychosis (schizophrenia) or bipolar disorder, especially in children
and adolescents, in order to enable early intervention, and ii) evaluating different
intervention strategies, especially pharmacotherapy, during the subsyndromal or “prodromal”
stages of these severe and often debilitating disorders. The different approaches
regarding the psychotic and bipolar clinical high-risk state are discussed, including
reasons and evidence for early (pharmacological) intervention and risks of treatment
vs. non-treatment. Only 10 prospective studies of antipsychotics (randomized=4) and
6 prospective studies of non-antipsychotic pharmacologic agents (randomized=3, i. e.,
omega-3 fatty acids=2, glycine=1) for the psychotic clinical high-risk state and only
4 prospective studies of mood stabilizing medications for the bipolar clinical high-risk
state (randomized=2, i. e., lithium=1, valproate=1) were detected. Based on the minimal
efficacy data, adverse effect risks, especially in pediatric populations, nonspecific
psychopathology, and unknown true risk for the development of either psychosis or
bipolar disorder or of chronically disabling symptoms and disability, medication treatment
currently remains second choice after psychosocial intervention. Additional research
in this area is clearly needed in order to shed more light on the relevance and predictive
value of potentially prodromal symptoms, their identification and most appropriate
management options.
Key words
early intervention - high risk - prodrome - schizophrenia - bipolar disorder
