Abstract
Pharmacologic intervention at the earliest stages of suspected psychotic illness is an intuitively appealing concept and a logical extension of the current approach to many other diseases of the central nervous system. Atypical antipsychotic agents (ATAPs) seem to be a reasonable choice for early intervention because existing pre-clinical data suggest that they have pharmacologic properties which might confer ‘neuroprotection’. However, a critical analysis of the results of structured clinical investigations which have explored the use of ATAPs for new-onset psychotic symptoms raises safety concerns and does not support pre-medication in this setting as a preventive strategy. Caution in current practice is therefore appropriate, underscoring the need for much additional clinical research.