The nature of schizophrenia: signposts to prevention

Objective: To describe the characteristics of schizophrenia relevant to con ducting indicated preventive interventions. Method: A systematic review of the literature informed by experiences at th e Personal Assistance and Crisis Evaluation (PACE) clinic. Results: Primary prevention requires a sophisticated knowledge of key causa l risk factors relevant to the expression of a disorder. The causal risk fa ctors most useful from an intervention standpoint may tum out to be somewha t removed from the neurobiology of the disorder and may even be relatively non-specific, so that tackling them could reduce the risks for a range of m ental disorders. The frontier for more specific prevention in schizophrenia and related psychosis is currently represented by indicated preventive int erventions for subthreshold symptoms. Again, these may be relatively broad spectrum early in the prepsychotic phase but more proximal to onset, greate r treatment specificity can be explored. However, this can be viewed more a s preventively orientated treatment rather than primary prevention per se. Early detection of first episode psychosis and optimal intensive treatment of first episodes and the critical early years after diagnosis also represe nt increasingly attractive preventive foci in psychotic disorders. Conclusion: As evidence accumulates, implementation of evidence-based pract ice in real work settings is a major challenge as it is throughout the ment al health service system. The momentum of preventively orientated treatment must be maintained through the 2nd National Mental Health Strategy and in the face of recent misleading polemic regarding the treatability of psychot ic disorders, especially schizophrenia. The evidence demonstrates that schi zophrenia and related disorders have never been more treatable.