Family and twin strategies as a head start in defining prodromes and endophenotypes for hypothetical early-interventions in schizophrenia

In an effort to share the experiences of 'genotype-hunters' - who have approached the difficult task of forecasting future schizophrenia in the young offspring or other relatives of index cases, in new samples guided by the prior probabilities of 15% in offspring or 50% in identical co-twins - with 'early-interventionists' - who focus on purported prodromal symptoms in children who would be treated pharmacologically to prevent the development of schizophrenia - we provide a focused review that emphasizes the hazards of false positives in both approaches. Despite the advantages prospective high-risk strategies have had from clinical and laboratory findings that implicate some prodromal signs and endophenotypes, e.g. attention, memory, and information processing evaluations, the yields are not sufficient for practical applications involving antipsychotic drugs for undiagnosed children. Even more caution than usual is required, given the suggestions that the developing neocortex is vulnerable to dopaminergic exposure.