Ethical aspects of early detection and intervention in a prepsychotic phase of schizophrenia

Abstract

Background Over the last 10-20 years, a growing interest in early detection and intervention in psychosis has been generated by studies suggesting that early treatment might improve the outcome. The interest in the early psychosis paradigm began with the focus on first-episode psychosis. More recently, attention has extended to the prepsychotic phase. Intervention in this early phase of illness point toward the possibility of attaining true prevention of psychotic disorders, including schizophrenia. The focus on the prepsychotic phase has been followed by an increased debate on the risks and benefits of early detection and intervention and discussion around the ethical questions raised when intervening in a putatively prepsychotic phase.

Aim and method In this paper I wish to give an overview of the literature on the ethical aspects of intervening in a prepsychotic phase. The articles this paper is based on are found searching PubMed and PsychINFO.

Results The benefits of early intervention are listed first. Then what is problematic about intervening in a prepsychotic phase is discussed, including conceptualization of the putatively prepsychotic phase, the false positives, different types of intervention and potential side effects, stigma and informed consent.

Conclusion New concepts are needed for prospective description of emergent psychosis. Further modifications of the criteria identifying those at high risk for psychosis would be beneficial. Research results suggest that new atypical antipsychotic medication, SSRI and cognitive behavioural therapy may have some efficacy for people thought to be in a prepsychotic phase. Controversy remains about side effects of intervention, especially those of antipsychotic medication. Early detection and intervention in psychosis is a new field in research, and further research and ethical debate is therefore needed.