More threads by David Baxter PhD

David Baxter PhD

Late Founder
Schizophrenia Treatment Starting With Earliest Signs
Tuesday, September 11, 2007

When strange voices echo through your head and strange visions dance before your eyes, you are too late to stave off a psychotic episode. The psychotic break that usually first strikes schizophrenics in early adulthood is extremely frightening for both the sufferers and their loved ones. By the time the first break occurs, it usually heralds a life of chronic problems and monitoring. Unwilling to sit on their hands until a problem arises, some doctors are working on a way to detect and treat schizophrenia before it becomes full-grown psychosis.

The key to early detection lies in the prodromal symptoms that have been observed years before the hallucinations and delusions necessary for a schizophrenia diagnosis. Some of the most common precursors are social withdrawal and problems communicating or concentrating. The North American Prodrome Longitudinal Study, published in the May issue of the Schizophrenia Bulletin, compiled a useful database of predictors observed in studying 888 at-risk people. Doctors Paul Moller and Ragnhild Husby have been working on a way to classify all of the prodromal symptoms into naturalistic categories that families can recognize. The theoretical work is paying off and we are excited to be able to report on a few programs that are making practical use of predictive symptoms.

The TIPS program in Norway was designed to compare the results of early schizophrenia treatment with normal treatment. In the test region of Rogaland, where publicity campaigns educated citizens and urged them to report symptoms as early as possible, psychosis went untreated for an average of only 5 weeks as opposed to 16 weeks in control areas. Patients from Rogaland were better integrated into society (for example, 50% of Rogaland schizophrenics managed to stay employed) and scored significantly healthier on the Positive and Negative Syndrome Scale.

With solid evidence from TIPS that early treatment is highly effective, programs like the Prevention Through Risk Identification, Management and Education (PRIME) Clinic have been getting a lot of deserved attention. The PRIME Clinic, located in a low-key, low-stigma building on the University of Toronto campus, was the focus of a Psychiatric News article last week. Patients are encouraged to come in voluntarily when they have the vague feeling that "something is wrong" - but have not yet lost touch with reality. The patients are regularly monitored so that even if therapy does not prevent a psychotic break, doctors can begin treatment as quickly as possible.

Dr. Jean Addington told Psychiatric News that while he is proud that his clinic is able to successfully predict schizophrenia 20-30% of the time using prodromal criteria, this number is not high enough to justify using medication. As it is clear that early treatment is crucial, researchers should continue to refine their understanding of prodromal symptoms so that more accurate predictions become possible. No one should have to encounter the nightmare of psychosis without warning and the chance to first put up a fight.
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