Schizophrenia Prodromal Treatment

  • One in 3 teens identified as high risk will have a first psychotic episode within three years, according to Thomas Insel on his NIMH blog dated November 20, 2014.


    According to Insel: "They are not actively psychotic, but they may be struggling in school, dealing with odd thoughts, and becoming socially isolated. Some describe brief hallucinations or paranoid ideas. Many have become 'basement kids,' playing video games alone most of the week and losing interest in the world above ground."


    Insel, Director of NIMH, asks if we can predict which teens will develop a psychotic illness. In most studies, the majority of “high-risk” individuals never go on to develop a psychotic disorder. The North American Prodrome Longitudinal Study (NAPLS) has improved prediction—over 70 percent of those identified as high risk went on to develop psychosis.

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    This sets a precedent: risk for psychosis can be accurately detected in someone with prodromal symptoms. Insel notes in his blog that "the accuracy appears equal to or better than our predictions of heart disease or dementia."


    Yet he's the messenger of other news too: "We don’t yet have an intervention proven to prevent psychosis in those at risk. Several interventions have been tried, but most of the trials have had so few people converting to psychosis in either the treated or the control conditions, that efficacy was impossible to assess."


    Insel elaborates: "A promising result with omega-3 fatty acids is currently being tested in a multi-site replication study. Antipsychotic or antidepressant medications do not appear useful for reducing conversion to psychosis in the few, small studies reported thus far."


    According to the NIMH Director: The most important question to be answered remains: what is the best way to prevent psychosis?...Given the morbidity and mortality of psychotic illnesses, there can be little doubt that we need interventions to prevent its onset. Even delaying the onset of psychosis for five years could make a huge difference in outcomes.


    In my next SharePost, I will talk about my own experiences in the prodromal stage and why I think effective "treatment" at this stage of my illness halted the impact of the illness when I had my first episode.


    I stand by these efforts to treat young people before the schizophrenia becomes a chronic, life-long illness. 


    A cure doesn't exist, yet it's possible for a significant number of individuals to recover or be recovered with the right treatment. 


    In effect, the illness is, in its symptomatology, gone from our lives.

Published On: November 30, 2014