Can We Prevent or Delay Schizophrenia?
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 At home, she appeared increasingly withdrawn and isolated, spending hours sleeping or watching television.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. She 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
- Seeing or hearing things that are not really there
- Acting or speaking in an unusual way that does not make 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
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 medications are stopped. Since there is no perfect test for early schizophrenia, 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.
National Alliance on Mental Illness
Mental Health America
Canadian Psychiatric Association
Children's Mental Health Ontario
About the first episodes of psychosis. National Alliance of Mental Illness website. Available at: http://www.nami.org/Template.cfm?Section=First%5FEpisode. Accessed February 17, 2014.
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 researchin schizophrenia psychoses: current estimatesof benefit and risk. Schizophrenia Bulletin. 2001;27(4):563-570.
Schizophrenia. EBSCO DynaMed website. Available at:http://www.ebscohost.com/dynamed/. Updated February 7, 2014. Accessed February 17, 2014.
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 February 17, 2014.
- Reviewer: Michael Woods, MD
- Review Date: 02/2014
- Update Date: 02/17/2014