Identification and treatment of the prodromal phase of psychotic disorders: perspectives from the PACE Clinic

Aim: To describe the development of the field of prodromal intervention in psychotic disorders and to summarize the findings from the PACE Clinic, the inaugural service devoted to this area. Method: A review of the PACE Clinic studies, with reference to the work of other groups. Results: The aims of intervention before the onset of psychosis are to alleviate current distress and impairment and to either prevent, delay or ameliorate the onset of more severe psychotic disorder. To do this, it is necessary to be able to first accurately identify those in the earliest stages of a potentially serious psychotic disorder, and second to effectively slow or prevent progression to more advanced illness. Criteria have been developed which have predicted onset of psychotic disorder in over 30% of so-called 'ultra high risk' individuals. Treatment trials have been promising, and to date have examined the effects of antipsychotic medication, cognitive therapy and a combination of the two. Recently, omega-3 fatty acids have also been shown to be effective. However, there are also pitfalls of working in the prodromal area, including ethical concerns and more recently the possibility that there is a decline in the rate of transition from ultra-high-risk state to first-episode psychosis. Conclusions: The field of prodromal intervention in psychotic disorders is an exciting one as it offers the possibility of prevention of full-blown disorder and its related negative sequelae. However, there are many issues that need to be dealt with in order to achieve this goal, and ongoing evaluation of methods to identify and treat such individuals is needed.