More threads by David Baxter PhD

David Baxter PhD

Late Founder
New Evaluation More Accurately Predicts Schizophrenia
Tuesday, January 08, 2008

Schizophrenia is the most common psychosis, and one of the most devastating, but its dark image is slowly brightening. For most of the 20th century, it was considered a disorder that struck without warning, turning perfectly normal teenagers into violent and untreatable wards of the state. More recently, many successful programs have demonstrated that schizophrenics can be safely reintegrated into society. Research has also shown that is possible to predict psychotic breaks so that there is time for preparation and perhaps even prevention. Two press releases this week from the NIMH herald significant progress towards prediction and treatment.

By observing children who are known to be at high risk for schizophrenia because of their family history, psychiatrists noticed that there is usually a prodromal phase that begins a year or more before a diagnosis, wherein the person develops a variety of problems that adversely affect their life without crossing into full psychosis. For example, those who think that people are following them are not psychotic if they can be assured, when presented with evidence that disputes this suspicion. But having such suspicions at all remains a warning sign.

Paranoia is just one of many warning signs that NIMH researchers used in an attempt to create a schizophrenia evaluation with the most positive predictive power (PPP). The new evaluation has prediction algorithms that focus on three main risk factors: bizarre beliefs or paranoia, genetic risk combined with recent functional decline, and social impairment. Prior drug use was also an important, independent risk variable. The results from this impressive new evaluation appear in this month's Archives of General Psychiatry.

One of the most widely used tests, the Structured Interview for Prodromal Syndromes (SIPS), had been able to achieve a PPP of only 35%, but this new, as-yet unnamed evaluation achieved a PPP of 74%-81%. This rate is as high as the one we recently wrote about for an innovative new test that measures a subject's proclivity to think that they heard intelligible phrases from gibberish recordings. But the NIMH study has a few advantages. Firstly, the evaluation that they developed relies on standard factors that all psychiatrists know how to collect. These red flags can even be gathered by a family member; though the result will not be a rigorous statistical analysis, it might still be helpful for families to know what to look for and what signs are the most predictive. Secondly, the NIMH study, involving 291 subjects, is almost three times as large as any pervious test of an evaluation method. Schizophrenia is relatively rare, and it is hard to gather a large pool of at-risk subjects. The hearing test mentioned above, for example, only had 43 people to evaluate.

The high PPP and the large size of the NIMH study are exciting. It is not clear to what extent schizophrenia's course can be changed in the prodromal phase, but other studies have shown that intervention in the early psychotic stage leads to better outcomes. It stands to reason that intervention even before psychosis would have be even more helpful. Even if it is not, an early warning will allow loved ones and the affected individual time to create the best treatment plan. The NIMH announced on Friday that two large grants were awarded to scientists trying to improve care methods for schizophrenics, so families will hopefully have many good options to choose from.
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