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Pre-Emptive Psychiatry: Preventing Illness and Promoting Recovery

Two decades ago, Mrazek and Haggerty25 stated that

The best hope now for the prevention of schizophrenia lies with indicated preventive interventions targeted at individuals manifesting precursor signs and symptoms who have not yet met full criteria for diagnosis. The identification of individuals at this early stage, coupled with the introduction of pharmacological and psychosocial interventions, may

prevent the development of the full-blown disorder. (p. 15)

Around the same time, a contributor to the Institute of Medicine report on reducing the risk for mental disorders,25 William Eaton,26 proposed that subthreshold syndromes could be regarded as risk factors for full-threshold disorders, such as schizophrenia, and, as such, these subthreshold syndromes could become the targets for preventive interventions to reduce risk of fully fledged disorder. A cross-diagnostic subthreshold focus has great potential27 and is central to the clinical staging model.28-31 Two decades later, although we have made major advances in neuroscience and the neurobiological basis of mental disorders, we still lack accurate predictive tools to augment the predictive power of the early clinical phenotypes that are required for a truly preventive psychiatry.32 We can safely assume that the emergence and persistence of mental illness is influenced by risk and protective factors, certain of which may be modifiable and which form part of a heuristic clinical staging framework that underpins much of our current approach to early intervention and pre-emptive treatment in the serious mental illnesses.28,29,33

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