Skip to main content
SpringerLink
Log in
Book cover

Ethics in Psychiatry pp 235–262Cite as

Prevention and Early Treatment

  • Chapter
  • First Online:

Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 45))

Abstract

For nearly two decades, prevention, and especially the indicated prevention of severe mental disorders has increasingly become a target of psychiatric research and, consequently, of ethical debates. The main focus and critic of the latter is on the accuracy of prediction and the safety of treatment, though concerns and arguments vary with the different characteristics of the considered disorder. Taking endogenous psychoses, Alzheimer’s disease (AD) and Huntington’s disease (HD) as examples, costs and benefits of an early detection, of an early intervention and of prevention research in the prodromal or premorbid phase, though heavily intertwined, will be examined with special emphasis on aspects of patient’s autonomy including considerations on informed consent and the ethical principles of nonmaleficence and beneficence.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Notes

  1. 1.

    Sass (1992, S. 13): ‘Pflicht zum Wissen und […] Recht auf Nichtwissen’ (cited according to Strech 2005).

  2. 2.

    In ICD-10 (WHO 1991) and DSM-IV (APA; American Psychiatric Association 1994), a prodrome is explicitly acknowledged for the majority of first-episode schizophrenia patients and is considered as part of both the time and the disability criterion, but, for its assumed unspecific nature, not as a diagnostic criterion per se.

  3. 3.

    Concerns about confidentiality to protect persons identified as being at-risk of a serious (neuropsychiatric) disorder from insurance discrimination are highly dependent in their relevance from the national health insurance system and a particular concern in countries with mainly private insurances such as the US (Corcoran et al. 2005).

  4. 4.

    A patient’s competence to consent might already be compromised by the evolving neuropsychiatric disorder or s/he might still be a minor (see related discussion in Section 16.4).

  5. 5.

    For example, participation in breast cancer screening will lead to a 25% RRR of death (i.e., to a reduction from four to three cases out of 1,000 women of the general population over the age of 35), while the ARR is only 0.1% and, consequently, the NNT to prevent one case of death is 1,000 (Strech 2005). For comparison at a 5%-rate of false-positive predictions, the ‘number needed to harm’ (Strech 2005, p. 106) would only be 50, i.e., 50 of 1,000 women would unnecessarily be confronted with a positive test result and the related potential negative consequences.

  6. 6.

    Not meeting the WHO’s criteria of ‘health’ cannot be equalled with being ‘ill’ (Helmchen 2003, 2005b). Even more than in somatic medicine, in psychiatry, the lack of clear-cut somatic/genetic diagnostic criteria has led to ongoing debates about the concept or comprehension of ‘psychiatric illness’ and about the very existence of psychiatric diseases (Helmchen 2003). Therein, the traditional, aetiopathologically oriented concept of illness has increasingly been complemented by an intervention oriented concept of disorder in that ‘disablement’ including the dimensions of impairment, disability and handicap is given more emphasis (Helmchen 2003).

  7. 7.

    Although the ability to consent should always be assessed in each patient, reliable guidelines or instruments for the assessment of competence are still wanting (see also Chapter 14).

  8. 8.

    For the dependence of research on moral and social attitudes and national legal regulations, the general framework in that EDI research is conducted varies across countries. A description of this intertwinement of research, societal attitudes and medical laws in the Netherlands is given by Evert van Leeuwen (2001).

  9. 9.

    In case of EI studies, this should also include information on NNT and/or ARR (see above) and should ensure that a ‘therapeutic misconception’ (Appelbaum et al. 1982), i.e., the perception of research as personalized care, is avoided.

  10. 10.

    The German central ethics committee (Zentrale Ethikkommission bei der Bundesärztekammer 2004) stated that the use of pharmaceuticals of insufficiently known age-specific efficacy and safety in minors was surely dubious from an ethical point of view, yet that this was rather common practice in their pharmacological treatment due to lack of research in this age-group. While posing additional safety and protection requirements for this group, the committee even voted for studies of mainly group-specific benefit if no alternative to such a trial would exist. The view that, under some conditions, a study posing a minor increase (that does not exceed the degree of risks ordinarily encountered in daily life) over minimal risk while offering no prospect of direct medical benefit is acceptable, is also shared by the US Common Rule (DeGrazia 2001).

Abbreviations

AD:

Alzheimer’s Disease

APA:

American Psychiatric Association

ARR:

Absolute Risk Reduction

DSM:

Diagnostic and Statistical Manual of Mental Disorders

ED:

Early Detection

EDI:

Early Detection and Intervention

EI:

Early Intervention

FTLD:

Frontotemporal Lobal Degeneration

HD:

Huntington’s Disease

ICD:

International Classification of Diseases

NNT:

Number Needed to Treat

RRR:

Relative Risk Reduction

WHO:

World Health Organization

YLD:

Years Lived with Disability

References

  • Addington J, Penn D, Woods SW et al (2008) Social functioning in individuals at clinical high risk for psychosis. Schizophr Res 99:119–124

    Google Scholar 

  • Amminger GP, Schäfer MR, Papageorgiou K et al (2008) Relationship between reduced erythrocyte membrane fatty acids and transition to psychosis in ultra high risk individuals. Schizophr Res 98:108

    Google Scholar 

  • APA, American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. DSM-IV. APA, Washington, DC

    Google Scholar 

  • Appelbaum PS, Roth LH, Lidz CW (1982) The therapeutic misperception: informed consent in psychiatric research. Int J Law Psychiatry 5:319–329

    Google Scholar 

  • Bak M, Myin-Germeys I, Delespaul P et al (2005) Do different psychotic experiences differentially predict need for care in the general population? Compr Psychiatry 46:192–199

    Google Scholar 

  • Barrera AZ, Torres LD, Muñoz RF (2007) Prevention of depression: the state of the science at the beginning of the 21st century. Int Rev Psychiatry 19:655–670

    Google Scholar 

  • Bayer JK, Hiscock H, Morton-Allen E et al (2007) Prevention of mental health problems: rationale for a universal approach. Arch Dis Child 92:34–38

    Google Scholar 

  • Bechdolf A, Pukrop R, Köhn D et al (2005) Subjective quality of life in subjects at risk for a first episode of psychosis: a comparison with first episode schizophrenia patients and healthy controls. Schizophr Res 79:137–143

    Google Scholar 

  • Bentall RP, Morrison AP (2002) More harm than good: the case against using antipsychotic drugs to prevent severe mental illness. J Ment Health 11:351–356

    Google Scholar 

  • Berger G, Dell’Olio M, Amminger P et al (2007) Neuroprotection in emerging psychotic disorders. Early Interv Psychiatry 1:114–127

    Google Scholar 

  • Berto P, D’Ilario D, Ruffo P et al (2000) Depression: cost-of-illness studies in the international literature: a review. J Ment Health Policy Econ 3:3–10

    Google Scholar 

  • Boyko EJ (1994) Ruling out or ruling in desease with the most sensitive or specific diagnostic test: short cut or wrong turn? Med Decis Making 14:175–179

    Google Scholar 

  • Briggs A, Spencer M, Wang H et al (2008) Development and validation of a prognostic index for health outcomes in chronic obstructive pulmonary disease. Arch Intern Med 168:71–79

    Google Scholar 

  • Brüggemann B (2007) Ethische Aspekte der Frühintervention und Akutbehandlung schizophrener Störungen [Ethics of early intervention and acute treatment of schizophrenic disorders]. Ethik Med 19:91–102

    Google Scholar 

  • Bühler KE, Haltenhof H (1992) Ethische Aspekte der Psychotherapie [Ethical aspects of psychotherapy]. Z Klin Psychol Psychopathol Psychother 40:364–377

    Google Scholar 

  • Candilis PJ (2003) Early intervention in schizophrenia: three frameworks for guiding ethical inquiry. Psychopharmacology (Berl) 171(1):75–80

    Google Scholar 

  • Chertkow H, Massoud F, Nasreddine Z et al (2008) Diagnosis and treatment of dementia: 3. Mild cognitive impairment and cognitive impairment without dementia. CMAJ 178:1273–1285

    Google Scholar 

  • Codori AM, Brandt J (1994) Psychological costs and benefits of predictive testing for Huntington’s disease. Am J Med Genet 54:174–184

    Google Scholar 

  • Conus P, Ward J, Hallam KT et al (2008) The proximal prodrome to first episode mania – a new target for early intervention. Bipolar Disord 10:555–565

    Google Scholar 

  • Corcoran C, Malaspina D, Hercher L (2005) Prodromal interventions for schizophrenia vulnerability: the risks of being “at risk”. Schizophr Res 73:173–184

    Google Scholar 

  • Cornblatt BA, Lencz T, Kane JM (2001) Treatment of the schizophrenia prodrome: is it presently ethical? Schizophr Res 51:31–38

    Google Scholar 

  • Correll CU, Penzner JB, Lencz T et al (2007) Early identification and high-risk strategies for bipolar disorder. Bipolar Disord 9:324–338

    Google Scholar 

  • David AS (2004) Is early intervention a waste of valuable resources? In: McDonald C, Schultz K, Murray R, Wright P (eds) Schizophrenia: challenging the orthodox. Taylor & Francis, London, New York, NY

    Google Scholar 

  • DeGrazia D (2001) Ethical issues in early-intervention clinical trials involving minors at risk for schizophrenia. Schizophr Res 51:77–86

    Google Scholar 

  • Dickerson BC, Sperling RA, Hyman BT et al (2007) Clinical prediction of Alzheimer disease dementia across the spectrum of mild cognitive impairment. Arch Gen Psychiatry 64:1443–1450

    Google Scholar 

  • Diehl-Schmid J, Pohl C, Perneczky R et al (2007) Frühsymptome, Überlebenszeit und Todesursachen – Beobachtungen an 115 Patienten mit Demenz auf der Grundlage frontotemporal lobärer Demenz [Initial symptoms, survival and causes of death in 115 patients with frontotemporal lobal degeneration]. Fortschr Neurol Psychiatr 75:708–713

    Google Scholar 

  • Europarat (2003) Draft additional protocol to the convention on human rights and biomedicine, on biomedical research. Steering Committee on Bioethics, Strasbourg, 23 Aug 2003

    Google Scholar 

  • Ferri CP, Prince M, Brayne C et al (2005) Global prevalence of dementia: a Delphi consensus study. Lancet 366:2112–2117

    Google Scholar 

  • Förstl H, Bickel H, Frölich L et al (2009) MCI-plus: leichte cognitive Beeinträchtigung mit rascher Progredienz. Teil I: Prävention und Therapie [MCI-plus: mild cognitive impairment with rapid progression. Part I: prevention and therapy]. Dtsch Med Wochenschr 134:39–44

    Google Scholar 

  • French P, Morrison AP (2004) Early detection and cognitive therapy for people at high risk of developing psychosis. Wiley, Chichester

    Google Scholar 

  • Gadamer HG (1993) Über die Verborgenheit der Gesundheit [On the seclusion of health]. Suhrkamp, Frankfurt am Main

    Google Scholar 

  • Gaebel W, Zäske H, Baumann AE (2006) The relationship between mental illness severity and stigma. Acta Psychiatr Scand 113(Suppl 429):41–45

    Google Scholar 

  • Grispini A (2003) Opportunities and limits of preventive strategies for schizophrenic disorders. Implications from an epigenetic-developmental model. In: Grispini A (ed) Preventive strategies for schizophrenic disorders. Giovanni Fioriti Editore srl, Rome

    Google Scholar 

  • Grundman M, Petersen RC, Ferris SH et al (2004) Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials. Arch Neurol 61:59–66

    Google Scholar 

  • Hanssen M, Bak M, Bijl R et al (2005) The incidence and outcome of subclinical psychotic experiences in the general population. Br J Clin Psychol 44:181–191

    Google Scholar 

  • Hauser M, Pfenning A, Özgurdal S et al (2007) Early recognition of bipolar disorder. Eur Psychiatry 22:92–98

    Google Scholar 

  • Helmchen H (2003) Krankheitsbegriff und Anspruch auf medizinische Leistungen [Comprehension of illness and utilization of medical resources]. Nervenarzt 74:395–397

    Google Scholar 

  • Helmchen H (2005a) Ethische Implikationen plazebokontrollierter Prüfungen von Psychopharmaka [Ethical implications of placebo-controlled clinical trials for psychotropic drugs]. Nervenarzt 76:1319–1329

    Google Scholar 

  • Helmchen H (2005b) Zum Krankheitsbegriff in der Psychiatrie [The concept of disease in psychiatry]. Nervenarzt 77:271–275

    Google Scholar 

  • Helmchen H (2005c) Forthcoming ethical issues in biological psychiatry. World J Biol Psychiatry 6(Suppl 2):56–64

    Google Scholar 

  • Helmchen H (2008) Ethische Erwägungen in der klinischen Forschung mit psychisch Kranken [Ethical questions in clinical research with the mentally ill]. Nervenarzt 79:1036–1050

    Google Scholar 

  • Hogan DB, Bailey P, Black S et al (2008) Diagnosis and treatment of dementia: 4. Approach to management of mild and moderate dementia. CMAJ 179:787–793

    Google Scholar 

  • Jansson ET (2005) Alzheimer disease is substantially preventable in the United States – review of risk factors, therapy, and the prospects for an expert software system. Med Hypotheses 64:960–967

    Google Scholar 

  • Joa I, Johannessen JO, Auestad B (2008) The key to reducing duration of untreated first psychosis: information campaigns. Schizophr Bull 34:466–472

    Google Scholar 

  • Kaduszkiewicz H, Röntgen I, Mossakowski K et al (2008) Tabu und Stigma in der Versorgung von Patienten mit Demenz. Kann ein Fortbildungsangebot für Hausärzte und ambulante Pflegedienste zur Destigmatisierung beitragen? [Stigma and taboo in dementia care – does continuing education for GPs and nurses contribute to destigmatisation?]. Z Gerontol Geriatr. Epub 8 Sept 2008. doi:10.1007/s00391-008-0569-0

    Google Scholar 

  • Kim SY, Appelbaum PS (2006) The capacity to appoint a proxy and the possibility of concurrent proxy directions. Behav Sci Law 24:469–478

    Google Scholar 

  • Kim SY, Kim HM, McCallum C et al (2005) What do people at risk for Alzheimer disease think about surrogate consent for research? Neurology 65:1395–1401

    Google Scholar 

  • Klosterkötter J, Schultze-Lutter F, Ruhrmann S (2008) Kraepelin and psychotic prodromal conditions. Eur Arch Psychiatry Clin Neurosci 258(Suppl 2):74–84

    Google Scholar 

  • LaMontagne AD, Keegel T, Vallance D (2007) Protecting and promoting mental health in the workplace: developing a systems approach to job stress. Health Promot J Austr 18:221–228

    Google Scholar 

  • Lappin JM, Dazzan P, Morgan K et al (2007) Insight in individuals with an at risk mental state. Schizophr Res 90:238–244

    Google Scholar 

  • Larsen TK, Friis S, Haahr U et al (2001) Early detection and intervention in first-episode schizophrenia: a critical review. Acta Psychiatr Scand 1003:323–334

    Google Scholar 

  • Lauber C, Rössler W (2003) Relatives and their attitude to early detection of schizophrenic psychosis. Psychiatr Bull 27:134–136

    Google Scholar 

  • Lauber C, Schmid-Diebold H, Rössler W (2001) Die Einstellung von Angehörigen psychisch Kranker zu psychiatrischer Forschung, insbesondere zur Früherfassung von schizophrenen Psychosen [Attitudes to psychiatric research, early detection of schizophrenic psychosis, and stigmatization: a survey with relatives of mentally ill patients]. Psychiatr Prax 28:144–146

    Google Scholar 

  • Levey A, Lah J, Goldstein F et al (2006) Mild cognitive impairment: an opportunity to identify patients at high ridsk for progression to Alzheimer’s disease. Clin Ther 28:991–1001

    Google Scholar 

  • Machleidt W, Brüggemann BR (2008) Sozialpsychiatrische und ethische Überlegungen zur Prävention schizophrener Störungen [Socialpsychiatric and ethical reflections about prevention of schizophrenic disorders]. Fortschr Neurol Psychiatr 76:97–105

    Google Scholar 

  • Mäki P, Veijola J, Jones PB (2005) Predictors of schizophrenia – a review. Br Med Bull 73 and 74:1–15

    Google Scholar 

  • McGlashan TH (2001) Psychosis treatment prior to psychosis onset: ethical issues. Schizophr Res 51:47–54

    Google Scholar 

  • McGlashan TH, Addington J, Cannon TD et al (2007) Recruitment and treatment practices for help-seeking “prodromal” patients. Schizophr Bull 33:715–726

    Google Scholar 

  • McGlashan TH, Johannessen JO (1996) Early detection and intervention with schizophrenia: rationale. Schizophr Bull 22:201–222

    Google Scholar 

  • McGorry PD (1998) “A stitch in time”…the scope for preventive strategies in early psychosis. Eur Arch Psychiatry Clin Neurosci 248:22–31

    Google Scholar 

  • McGrath J (2003) Prevention of schizophrenia – not an impossible dream. In: Murray RM, Jones PB, Susser E et al (eds) The epidemiology of schizophrenia. Cambridge University Press, Cambridge

    Google Scholar 

  • McNeil BJ, Keeler E, Adelstein SJ (1975) Primer on certain elements of medical decision making. N Engl J Med 293:211–215

    Google Scholar 

  • Meincke U, Kosinski Ch, Zerres K et al (2003) Psychiatrische und ethische Aspekte genetischer Diagnostik am Beispiel der Chorea Huntington [Psychiatric and ethical aspects of genetic diagnostics in cases of Huntington’s disease]. Nervenarzt 74:413–419

    Google Scholar 

  • Morris JC, Storandt M, Miller JP et al (2001) Mild cognitive impairment represents early stage Alzheimer disease. Arch Neurol 58:397–405

    Google Scholar 

  • Mrazek PJ, Haggerty RJ (1994) Reducing risks for mental disorders: frontiers for preventive intervention research. National Academy Press, Washington, DC

    Google Scholar 

  • MRC-BTWP (1990) Prognostic factors for high-grade malignant glioma – development of a prognostic index – a report of the Medical Research Council Brain-Tumor Working Party. J Neurooncol 9:47–55

    Google Scholar 

  • Myin-Germeys I, van Os J, Schwartz JE et al (2001) Emotional reactivity to daily life stress in psychosis. Arch Gen Psychiatry 58:1137–1144

    Google Scholar 

  • Ochoa S, Haro JM, Torres JV et al (2008) What is the relative importance of self reported psychotic symptoms in epidemiological studies? Results from the ESEMeD – Catalonia study. Schizophr Res 102:261–269

    Google Scholar 

  • Okonkwo O, Griffith HR, Belue K (2007) Medical decision-making capacity in patients with mild cognitive impairment. Neurology 69:1528–1535

    Google Scholar 

  • Patterson C, Feighner JW, Garcia A et al (2008) Diagnosis and treatment of dementia: 1. Risk assessment and primary prevention of Alzheimer disease. CMAJ 178:548–556

    Google Scholar 

  • Penn DL, Kohlmaier JR, Corrigan PW (2000) Interpersonal factors contributing to the stigma of schizophrenia: social skills, perceived attractiveness and symptoms. Schizophr Res 45:37–45

    Google Scholar 

  • Penn DJ, Martin J (1998) The stigma of severe mental illness: some potential solutions to a recalcitrant problem. Psychiatr Q 69:235–247

    Google Scholar 

  • Post SG (2001) Preventing schizophrenia and Alzheimer disease: comparative ethics. Schizophr Res 51:103–108

    Google Scholar 

  • Preda A, Miller TJ, Rosen JL et al (2002) Treatment histories of patients with a syndrome putatively prodromal to schizophrenia. Psychiatr Serv 53:342–344

    Google Scholar 

  • Richards FH (2008) Predictive genetic testing of adolescents for Huntington disease: a question of autonomy and harm. Am J Med Genet A 146A:2443–2444

    Google Scholar 

  • Rosen A (2000) Ethics of early prevention in schizophrenia. Aust N Z J Psychiatry 34(Suppl):S208–S212

    Google Scholar 

  • Rosen JL, Miller TJ, D’Andrea JT et al (2006) Comorbid diagnoses in patients meeting criteria for the schizophrenia prodrome. Schizophr Res 85:124–131

    Google Scholar 

  • Rössler W, Riecher-Rössler A, Angst J et al (2007) Psychotic experiences in the general population: a twenty-year prospective community study. Schizophr Res 92:1–14

    Google Scholar 

  • Ruhrmann S, Paruch J, Bechdolf A et al (2008) Reduced subjective quality of life in persons at risk for psychosis. Acta Psychiatr Scand 117:357–368

    Google Scholar 

  • Ruhrmann S, Schultze-Lutter F, Klosterkötter J (2009) Intervention in the at-risk state to prevent transition to psychosis. Curr Opin Psychiatry 22(2):177–183

    Google Scholar 

  • Ruhrmann S, Schultze-Lutter F, Salokangas RKR et al (2010) Prediction of psychosis in adolescents and young adults – results from a prospective european multicenter study (EPOS). Arch Gen Psychiatry 67(3):241–251

    Google Scholar 

  • Rüsch N, Angermeyer MC, Corrigan PW (2005) Das Stigma psychischer Erkrankungen: Konzepte, Formen und Folgen [The stigma of mental illness: concepts, forms, and consequences]. Psychiatr Prax 32:221–232

    Google Scholar 

  • Sackett DI (1991) Clinical reality, binary models, babies and bath water. J Clin Epidemiol 44:217–219

    Google Scholar 

  • Sackett DI (1992) A primer on the precision and accuracy of the clinical examination. J Am Med Assoc 267:2638–2644

    Google Scholar 

  • Sackett DI, Haynes RB, Tugwell P (1985) Clinical epidemiology: a basic science for clinical medicine. Little & Brown, Boston, MA

    Google Scholar 

  • Sass HM (1992) Informierte Zustimmung als Vorstufe zur Autonomie des Patienten [Informed consent as a first step towards patient’s autonomy]. Medicoethical Materials, Broschure 78. Centre for Medical Ethics, Bochum

    Google Scholar 

  • Schultze-Lutter F (2009) Subjective symptoms of schizophrenia in research and the clinic: the basic symptom concept. Schizophr Bull 35:5–8

    Google Scholar 

  • Schultze-Lutter F, Klosterkötter J, Picker H et al (2007) Predicting first-episode psychosis by basic symptom criteria. Clin Neuropsychiatry 4:11–22

    Google Scholar 

  • Schultze-Lutter F, Ruhrmann S (2008) Früherkennung und Frühbehandlung von Psychosen [Early detection and early treatment of psychoses]. Uni-Med, Bremen

    Google Scholar 

  • Schultze-Lutter F, Ruhrmann S, Klosterkötter J (2008) Early detection and early intervention in psychosis in Western Europe. Clin Neuropsychiatry 5:303–315

    Google Scholar 

  • Simon AE, Cattapan-Ludewig K, Zmilacher S et al (2007) Cognitive functioning in the schizophrenia prodrome. Schizophr Bull 33:761–771

    Google Scholar 

  • Sperduto PW, Berkey B, Gaspar LE et al (2008) A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys 70:510–514

    Google Scholar 

  • Strech D (2005) Der Umgang mit Wahrscheinlichkeiten und das Vertrauen in die Medizin [Dealing with probabilities and confidence in medicine. Ethical and scientific aspects of evidence-based medicine in cancer screening]. Ethik Med 17:103–113

    Google Scholar 

  • Sullivan SH (1927) The onset of schizophrenia. Am J Psychiatry 151:135–139

    Google Scholar 

  • Suvisaari JM, Haukka JK, Tanskanen AJ et al (1999) Decline in the incidence of schizophrenia in Finnish cohorts born from 1954 to 1965. Arch Gen Psychiatry 56:733–740

    Google Scholar 

  • Taylor SD (2004) Predictive genetic test decisions for Huntington’s disease: context, appraisal and new moral imperatives. Soc Sci Med 58:137–149

    Google Scholar 

  • van Leeuwen E (2001) Dutch law and ethics concerning the experimental treatment of early psychosis. Schizophr Res 51:63–67

    Google Scholar 

  • van Os J, Linscott RJ, Myin-Germeys I et al (2009) A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychol Med 39:179–195

    Google Scholar 

  • Veijola J, Jones P, Mäkikyrö T et al (2000–2001) Early association for schizophrenia in the 1966 North Finland general population birth cohort. Int J Ment Health 29:84–90

    Google Scholar 

  • Verdoux H, Cougnard A (2006) Schizophrenia: who is at risk? Who is a case? Int Clin Psychopharmacol 21(Suppl 2):S17–S19

    Google Scholar 

  • Verdoux H, Maurice-Tison S, Gay B et al (1998) A survey of delusional ideation in primary-care patients. Psychol Med 28:127–134

    Google Scholar 

  • Verdoux H, van Os J (2002) Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophr Res 54:59–65

    Google Scholar 

  • Vernooij-Dassen MJ, Moniz-Cook ED, Woods RT et al (2005) Factors affecting timely recognition and diagnosis of dementia across Europe: from awareness to stigma. Int J Geriatr Psychiatry 20:377–386

    Google Scholar 

  • WHO, World Health Organization (1991) Internationale Klassifikation psychischer Störungen: ICD-10, Kapitel V (F) [Tenth revision of the international classification of diseases, Chapter V (F): Mental and behavioural disorders]. Huber, Bern, Göttingen, Toronto, ON

    Google Scholar 

  • WHO, World Health Organization (2001) World Health Report 2001. WHO, Geneva

    Google Scholar 

  • WHO, World Health Organization (2003) Investing in mental health. WHO, Geneva

    Google Scholar 

  • WHO, World Health Organization (2004) Promoting mental health. WHO, Geneva

    Google Scholar 

  • Yung AR, Nelson B, Stanford C et al (2008) Validation of “prodromal” criteria to detect individuals at ultra high risk of psychosis: 2 year follow-up. Schizophr Res 105:10–17

    Google Scholar 

  • Yung AR, Phillips LJ, McGorry PD et al (1998) Prediction of psychosis. A step towards indicated prevention of schizophrenia. Br J Psychiatry 172(Suppl 33):14–20

    Google Scholar 

  • Zentrale Ethikkommission bei der Bundesärztekammer [Central Ethics Commitee of the Bundesärztekammer] (2004) Stellungnahme “Forschung mit Minderjährigen” [Statement “research in minors”]. Dtsch Ärztebl 101:A1613–A1617

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University of Cologne, D-50924, Cologne, Germany

    Joachim Klosterkötter

  2. Research Department, University Hospital of Child and Adolescent Psychiatry Bern (UPD), CH-3000 Bern 60, Bern, Switzerland

    Frauke Schultze-Lutter

Authors
  1. Joachim Klosterkötter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frauke Schultze-Lutter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frauke Schultze-Lutter .

Editor information

Editors and Affiliations

  1. Charité Campus Benjamin Franklin, Klinik für Psychiatrie/ Psychotherapie, Universitätsklinikum Berlin, Eschenallee 3, Berlin, 14050, Germany

    Hanfried Helmchen

  2. chemin Colladon 14, Geneve, 1209, Switzerland

    Norman Sartorius

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media B.V.

About this chapter

Cite this chapter

Klosterkötter, J., Schultze-Lutter, F. (2010). Prevention and Early Treatment. In: Helmchen, H., Sartorius, N. (eds) Ethics in Psychiatry. International Library of Ethics, Law, and the New Medicine, vol 45. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-8721-8_16

Download citation

  • DOI: https://doi.org/10.1007/978-90-481-8721-8_16

  • Published:

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-90-481-8720-1

  • Online ISBN: 978-90-481-8721-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation