I have a story in the Boston Globe today about the idea of prevention and early intervention in kids with mental health problems. In particular, the article focuses on early intervention for psychotic disorders–such as schizophrenia–an idea currently surrounded by a great deal of debate.
“In recent years, mental health specialists have identified a ‘psychosis risk syndrome,’ outlining symptoms that may present themselves long before an official diagnosis of schizophrenia could be made. The youths with this risk condition often have milder versions of schizophrenia’s hallmark hallucinations and delusions, and they typically have some insight into what they’re experiencing. They may say ‘ “The TV really seemed to be talking to me,” ’ says Larry Seidman, a clinical psychologist at Harvard Medical School. ‘Then the person will say, “No, I know that’s not real, but it seemed to be happening.” They’re scared by these symptoms. They worry that they’re losing their minds.’ ”
Some psychologists are fighting to have psychosis risk syndrome added to the upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders. These experts argue that making the syndrome “official” could encourage doctors to be on the lookout for the earliest signs of psychosis–and, potentially, prevent the development of serious disease. (Studies have suggested that early intervention could postpone the onset of schizophrenia and possibly even reduce its severity.)
But there’s a problem–many of the kids who meet the criteria for psychosis risk syndrome never go on to develop full- fledged psychosis. In fact, this so called conversion rate has actually been dropping over the last decade; today, fewer than 30 percent of patients with the syndrome actually end up with a diagnosable psychotic disorder (such as schizophrenia). As you can imagine, this creates a serious medical dilemma about whether, and how, to intervene. Do you medicate a teenager who, more than likely, will never develop schizophrenia? Would you, as a parent, be able to pass on a drug regimen that has a chance–even if it’s a small one–of protecting your child’s from such a devastating disease?
For more on these and other questions, see the full story in the Globe.
Though the story focuses on schizophrenia, these kinds of issues are, I think, destined to become much more common. The idea of prevention and early intervention is really gaining currency in psychiatry. Research projects are now focused on identifying the earliest possible signs of everything from anxiety to mood disorders, sometimes in kids as young as two.
The more we learn, the more we’ll be able to pick up on the subtlest symptoms of mental illness. That’s great news for the subset of kids that are actually on their way to developing serious psychiatric problems. The problem is: We’re simply not very good at determining which kids those are. I think patients, parents, and doctors are going to be wrestling with some of these issues for a long time to come.
In the July issue, Schizophrenia Research published a special section on psychosis risk syndrome.
Psychosis ran a series of editorials earlier this year covering the psychosis risk syndrome debate.