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Research studies for the treatment of the putative prodromal phase of
psychotic disorders have begun to appear
To obtain preliminary evidence of the short-term efficacy and safety of
aripiprazole treatment in people with the psychosis prodrome
Fifteen participants meeting prodrome criteria (mean age 17.1 years,
s.d.=5.5) enrolled in an open-label, single-site trial with
fixed-flexible dosing of aripiprazole (5–30 mg/day) for 8 weeks
In the mixed-effects repeated-measures analysis, improvement from
baseline on the Scale of Prodromal Symptoms total score was statistically
significant by the first week. No participant converted to psychosis and
13 completed treatment. Neuropsychological measures showed no consistent
improvement; mean weight gain was 1.2 kg. Akathisia emerged in 8
participants, but the mean Barnes Akathisia Scale score fell to baseline
levels by the final visit. Adverse events were otherwise minimal
Aripiprazole shows a promising efficacy and safety profile for the
psychosis prodrome. Placebo-controlled studies are indicated
This article discusses conceptual issues relevant to the prospective diagnosis of the schizophrenic prodrome. Recent efforts to diagnose these patients with operational criteria based on current symptoms are reviewed. Symptomatic patients so identified appear to be treatment-seeking and to have mild cognitive impairments. In addition to being currently symptomatic, these patients are imminently at risk for progression of illness and development of schizophrenia. Data from three international centers suggest that this risk is approximately 40% over the next year of follow-up if untreated. The implications of the reviewed data for the appropriateness of the term “prodromal” and for treatment/prevention research for these patients are discussed.
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