• Can We Prevent or Delay Schizophrenia?

    Rerun image Fifteen-year-old Caitlin was an excellent student with many friends when she entered the ninth grade. One year later, she suddenly became restless in school, stopped paying attention to her teachers, and eventually failed all of her subjects. At home, she appeared increasingly withdrawn and isolated, spending hours sleeping or watching television. The previously even-tempered adolescent became angry, anxious, and suspicious of those around her, and was occasionally seen talking to herself while making repetitive, odd hand motions. Several years later, hearing voices and insisting that the CIA was hatching an elaborate plot to murder her and her family, she was diagnosed with schizophrenia.
    If Caitlin had received help at the first sign of trouble, could her descent into psychosis have been prevented or delayed?

    Are There Early Warning Signs?

    Schizophrenia is a brain disorder that changes the way a person views reality, responds to others, and experiences emotion. It is a condition that affects every aspect of a person's life, including family relations, friendships, education, and career. While schizophrenia can manifest in different ways, early signs that can indicate a problem include:
    • Not caring about personal hygiene (eg, no longer showering)
    • Seeing or hearing things that are not really there
    • Acting or speaking in an unusual way (eg, not making sense)
    • Having disorganized thoughts
    • Having strange beliefs or magical thinking
    • Withdrawing from others
    • Not having any motivation
    • Feeling suspicious of others
    • Having dramatic changes in your sleep pattern
    There are programs in the United States and in other countries that focus on treating these early warning signs in an effort to prevent psychotic symptoms from developing any further. The Portland Identification and Early Referral (PIER) Program in Maine is one example. PIER aims to help children, teens, and young adults who are at risk for serious mental health conditions, like schizophrenia. If your child is struggling, for instance, the mental health professionals would assess him and create a treatment plan. Treatment may include educating the family about mental health disorders, providing the child support in school or at his job, and prescribing medicine if needed.

    Is Early Intervention Effective?

    Researchers attempted to answer this question by analyzing 18 studies that included 1,808 people with early signs of psychosis. Unfortunately, most of the studies were small and not well designed, making it difficult to draw firm conclusions. But several interventions—treatment by a specialized clinical team, family therapy, and support for employment—did appear to improve some outcomes, like complying more with treatment and being more likely to have a job.
    The idea of early intervention is not without its opponents. Clinicians worry that labeling people —especially children—as "high risk" or treating people "at risk for mental illness" might affect one's self-image. Also, drugs used to treat schizophrenia have many side effects, some of which may prove life-threatening and/or may continue even after medicines are stopped. Since there is no perfect test for early schizophrenia, inevitably some people who would never have developed schizophrenia will be labeled and treated.
    These concerns need to be weighed against the possibility that early intervention may be able to prevent or reduce the severe symptoms of schizophrenia. The fact remains that many people experience significant delays in treating newly developed psychosis. Some experts feel that rapid diagnosis and treatment of psychosis may be helpful in reducing the long-term effect of schizophrenia.

    RESOURCES

    National Alliance on Mental Illness http://www.nami.org/

    The National Mental Health Association http://www.nmha.org/

    CANADIAN RESOURCES

    Canadian Psychiatric Association http://www.cpa-apc.org/

    Children's Mental Health Ontario http://www.kidsmentalhealth.ca/

    References

    About PIER. Prevent Mental Illness website. Available at: http://www.preventmentalillness.org/aboutpier.html. Accessed June 28, 2012.

    First episodes of psychosis. National Alliance of Mental Illness website. Available at: http://www.nami.org/Template.cfm?Section=First%5FEpisode. Accessed June 28, 2012.

    Marshall M, Rathbone J. Early intervention for psychosis. Cochrane Database Syst Rev. 2011;(6):CD004718.

    McGlashan T, Miller T, Woods S. Pre-onset detection and intervention research in schizophrenia psychoses: current estimates of benefit and risk. Schizophrenia Bulletin. 2001;27(4):563-570.

    Schizophrenia. EBSCO DynaMed website. Available at:http://www.ebscohost.com/dynamed/ . Updated April 2, 2012. Accessed June 28, 2012.

    Schizophrenia: what you need to know. Mental Health America website. Available at: http://www.mentalhealthamerica.net/go/information/mental-health-info/schizophrenia/schizophrenia-what-you-need-to-know/schizophrenia-what-you-need-to-know. Accessed June 28, 2012.

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