Given the likelihood of involving a relatively high rate of false-positive identifications,

pre -illness intervention was not considered either feasible or ethical. However, the emergence of the new novel antipsychotics has changed this situation and has provided the tools for preventive intervention. Given the reduced side effects of the novel antipsychotics currently available,18-20 intervening early in the illness process, before psychosis sets in, has been increasingly regarded as ethically acceptable. Characterizing the prodrome The early studies of the prodromal stage Inhibitors,research,lifescience,medical of schizophrenia, conducted primarily in Germany, were typically retrospective and involved the recollection of the signs and symptoms preceding

onset by patients in the early stages of illness and their family members.21-23 The initial Inhibitors,research,lifescience,medical prodromal clinical assessment that emerged, the Bonn Scale for the Assessment of Basic Symptoms (BSABS),22,24,25 has had a major influence on the development of several subsequent measures, including: (i) the Instrument for the Retrospective Assessment of the Onset of Schizophrenia (IROAS), developed by Hafner Inhibitors,research,lifescience,medical and colleagues26,29; (ii) the Multidimensional Assessment of the Psychotic Prodrome (MAPP) used in the Personal Assessment and Crisis Evaluation (PACE) clinic assessments30; and, in turn, (iii) the Structured Interview for Prodromal Symptoms (SIPS) and Scale of Prodromal Symptoms (SOPS) developed by McGlashan and colleagues.31 With the exception of the BSABS,25 research concerned with the prospective

validity of prodromal assessments, especially those developed in the United States, has just begun.30-34 As a result, prodromal diagnostic Inhibitors,research,lifescience,medical MS-275 in vitro criteria are in the process of evolving. Inhibitors,research,lifescience,medical In terms of the definitions most widely used at present, much of the groundbreaking work has been carried out by McGorry and colleagues in Australia.30,32,34 Based on a series of creative early studies, they have developed a highly influential set of criteria for identifying prodromal individuals. Their system consists of three separate categories of selection criteria.35 Category 1 requires at least one of the following 3-mercaptopyruvate sulfurtransferase attenuated (ie, subthreshold) positive symptoms: ideas of reference, odd beliefs, or magical thinking; perceptual disturbance; odd thinking and speech; paranoid ideation; and odd behavior or appearance. Category 2 consists of individuals who have experienced transient psychotic symptoms that have spontaneously resolved within 1 week. Category 3 combines genetic risk (ie, being the first-degree relative of an individual with a diagnosis of schizophrenia) with state change in functioning (must have undergone a substantial decline in the previous year). These categories have also been integrated into the SIPS and SOPS developed by McGlashan and colleagues.