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 At home, she appeared increasingly withdrawn and isolated, spending hours sleeping or watching television.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, some experts believe that her descent into psychosis might have been prevented or delayed.
Researchers are trying to identify people who are at high risk of developing schizophrenia. They are also trying to treat at-risk people with antipsychotic medicine before full-blown symptoms have emerged.
Theories on Schizophrenia
There has been a shift in the understanding of schizophrenia. It is now believed to be a neurodevelopmental, biologically based brain disease with a strong genetic component.
The Recognition and Prevention of Psychological Problems (RAPPP) Program focuses on the detection of the prodromal features. This refers to the first behavior changes and symptoms that happen during the early stages of a mental illness. This program offers a range of treatment and early intervention strategies for young patients who have these early signs; including individual, family, and group therapy; social skills and nutrition training; and medicine.
Prodromal features associated with schizophrenia include:
Impairment in personal hygiene and grooming
Inappropriate affect (eg, laughing when talking about something sad)
Vague, overly elaborate, or circumstantial speech
Poverty of speech
Odd beliefs or magical thinking
Unusual perceptual experiences
Other features that may be significant warning signs of increased risk for schizophrenia or related disorders include:
The concept of predicting psychiatric disorders is relatively new, which has led to concerns about labeling people as "pre-schizophrenic" and medicating them when they are not showing definitive signs of the disorder. Clinicians worry about stigmatizing people defined as "high risk," as well as the possibility that being treated as "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. Until better early diagnosis becomes possible and the benefits of treatment are better proven, intervention before the development of psychosis should be regarded as experimental.
These concerns need to be weighed against the possibility that early diagnosis and intervention may be able to prevent a lifetime of crippling psychiatric disability. The fact remains, however, 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 and other disorders.
McGlashan TH. Commentary: progress, issues, and implications of prodromal research: an inside view.
McGlashan TH, Zipursky RB, Perkins D, et al.
The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. I. Study rationale and design.
Morrison AP, French P, Walford L, et al. Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial.
Br J Psychiatry
Yung AR, Phillips LJ, Yuen HP, et al. Psychosis prediction: 12-month follow up of a high-risk ("prodromal") group.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a