Lessons learned from Prodromal research: Bringing early identification and intervention in Public Health psychiatry

Lessons learned from Prodromal research: Bringing early identification and intervention in Public Health psychiatry Amresh Shrivastava MBBS, MD, DPM, MRCPsych. a Currently: Assistant Professor of Psychiatry, The University of western Ontario, & Associate Scientist, Lawson Health Research Institute, London, Physician team Leader: Early Intervention of Psychosis Program (Elgin-PEPP) Regional mental health care.St. Thomas.Ontario,Canada Executive Director , Mental Health Foundation of India (PRERANA Charitable trust) and Silver Mind Hospital, 209 Shivkripa Complex, Gokhale Road, Thane, Mumbai, Maharashtra, India 400 602, E Mail : amresh.edu@gmail.com Phone: 1-5196413233 Home, 1-5196318510 Office, fax 1-5196312512 word count : Abstract: 240 Text body : 6840 References: 53 Tables: 4 figure : 1 Abstract: Since last ten years significant research data has been gathered to identify and predict the vulnerability of individuals to develop psychosis. It is known as the high-risk group. Scientific community is excited with a number of positive findings in the field of at-risk psychosis, also referred as ultra high risk. At the time when DSM V academia is getting busy with field trials, researchers in prodromal psychosis research are arguing for inclusion of ‘risk syndrome for psychosis’. This has generated an interesting debate. Studies indicate that approx. 80-85% cases report to have experienced subsyndromal symptoms for a period lasting several months to several years prior to the onset of the illness. Such symptoms include impaired perception, thought processes, subjective cognitive functions and mood. Studies also suggest that much of functional decline associated with schizophrenia occurs during this prodromal phase. The major research achievements in this field have indicated that it is possible to identify candidates who might develop psychosis. It is also known that a delay in treatment compromises the outcome, most of the functional damage is caused much before the florid symptoms appear. Psychosis is a neurotoxic state. Once the ‘critical period’ for intervention is missed the treatment outcome shall remain poor. Function can be restored and quality of life be enhanced with a range of therapeutic intervention in early phase. The paper examines clinical & public health implications of the prodromal research. Key words: prodrome, at-risk, Risk Syndrome, Psychosis, schizophrenia, Early interventio