Several groups have begun to characterize the early versus late prodromal period.52,71 For example,

a treatment trial underway in Germany has randomized early-phase prodromal participants to receive a program of CBT or clinical management and randomized late-stage prodromal participants to clinical management alone or in conjunction with AP medication.71 Results from such studies will contribute to our understanding of when treatment should be most profitably initiated, what type of treatment Inhibitors,research,lifescience,medical is most appropriate for each prodromal phase, and the criteria most helpful in evaluating short-term treatment effects. This shift in focus may bring about novel interventions such as the use of newly marketed SGAPs, ADs, cognitive enhancers, glycine, /-cycloserine, hormones, and Inhibitors,research,lifescience,medical psychosocial interventions that target specific skill deficits (eg, social skills group). In addition, a collaborative effort under the leadership of Heinssen involving several prodromal research groups in the USA and Canada

(Principal Investigators: Addington, Inhibitors,research,lifescience,medical Cadenhead, Cannon, Cornblatt, McGlashan, Perkins, Seidman, Tsuang, Walker, and Woods), referred to as the North American Prodromal Longitudinal Study (NAPLS), has been recently formed to provide a common database with a large prodromal sample. This collaboration is expected to increase consistency between studies by developing Inhibitors,research,lifescience,medical common methodologies, common measurement instruments, and correspondence between definitions of conversion. Several other networks have been BKM120 in vivo initiated throughout Europe, including the European Prediction of Psychosis Study (EPOS) in Finland, led by Salokangas, and the Swiss Consortium currently headed by Simon. Such collaborations offer the hope that large databases will result, each with far more subjects and statistical power than possible for any study alone. Conclusions have thus far been Inhibitors,research,lifescience,medical elusive given the rarity of the prodromal state and the difficulty in ascertaining a substantial prodromal population. Large-scale collaborations offer the promise of generating a solid set

of generalizable conclusions about the prodrome, which are reliable, valid, and representative of a broad preschizophrenia population.53 Selected abbreviations and acronyms Isotretinoin AD antidepressant AP antipsychotic CBT cognitive behavioral therapy CHR clinical high risk NBI needs-based intervention PACE Personal Assessment and Crisis Evaluation (program) PRIME Prevention through Risk Identification, Management, and Education (program) RAP Recognition and Prevention (program) SGAP second-generation antipsychotic SLP schizophrenia-like psychosis SPI specific preventive intervention Notes This research was supported in part by National Institute of Mental Health grant MH-61523 to Dr Cornblatt. We would like to thank Ruth Olsen for her help with many of the technical aspects of this manuscript.