Commentary: Progress, Issues, and Implications of Prodromal Research: An Inside View

This issue of the Schizophrenia Bulletin focuses around research in the prodromal phase of severe mental illness, largely schizophrenia. The years since the last Bulletin issue on early detection and interven-tion have witnessed success at identifying the pro-drome prospectively, positive initial data about treat-ing prodromal symptoms and delaying psychosis onset, and hopeful data about elucidating the patho-physiology of psychosis through the prodrome. In this overview I will comment on some of the opportunities and challenges generated by this new line of research. Themes include the recruitment of prodromal sub-jects, characteristics of prodromal samples thus far collected, the process of conversion to psychosis in these samples, minimizing false positive prodromal subjects, dosing of drug treatments in prodromal clin-ical trials, treatment practice implications of prodro-mal research, defining conversion to psychosis prospectively, and screening, assessing, and naming the prodrome. It is concluded that prodromal research holds much promise but will require the for-mal collaboration of many investigators and the avail-ability of resources for sustained efforts to recruit what amounts to an incidence sample. "For thousands of years medicine has relied on what? On the fact that you have a core of people to whom you come when a disease has declared itself. Well, by that time things are really way down the path of destruction. So I believe strongly that in this century we're going to have to understand what I call the subclinical phase of diseases, where the disease is evolving in you but you feel nothing.&quot