15-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 At home, she appeared increasingly withdrawn and isolated, spending hours sleeping or watching television.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?
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:
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 such as schizophrenia. If your child is struggling, for instance, the mental health professionals would assess them and create a treatment plan. Treatment may include educating the family about mental health disorders, providing the child with support in school or on the job, and prescribing medication if needed.
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 early, aggressive diagnosis and early, aggressive treatment of psychosis may be helpful in reducing the long-term effects of schizophrenia, including delaying disease progression to psychosis.
National Alliance on Mental Illness
Mental Health America
Canadian Psychiatric Association
Children's Mental Health Ontario
First episode: psychosis. National Alliance of Mental Illness website. Available at: http://www.nami.org/psychosis/report. Published 2011. Accessed January 21, 2016.
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. Available at: http://schizophreniabulletin.oxfordjournals.org/content/27/4/563.full.pdf. Accessed January 21, 2016.
Schizophrenia. EBSCO DynaMed website. Available at:http://www.ebscohost.com/dynamed/. Updated October 23, 2015. Accessed January 21, 2016.
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 January 21, 2016.
4/29/2016 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Stafford MR, Jackson H, Mayo-Wilson E, Morrison AP, Kendall T. Early interventions to prevent psychosis: systematic review and meta-analysis. BMJ. 2013;346:f185.
Last reviewed January 2016 by Michael Woods, MD
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 medical condition.
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