Early Detection and Prevention of Schizophrenia

William Cook, Ph.D., the second speaker, talked about a creative program funded by the Robert Wood Johnson Foundation that uses families to indentify and reduce the severity of psychotic illness.  The Early Intervention Project showed how families can be instrumental in changing the course of the schizophrenia.

The PIER program was a randomized clinical trial of family-aided assertive community treatment, supported by the National Institute of Mental Health (NIMH).  Patients were moved into treatment before the onset of psychosis.  It is a revolutionary idea about how we think about psychosis and its prevention.  

Biological risk factors include genetic risk, non-genetic biological risks, pre-natal infections (influenza) and pre-natal toxic exposure (lead), birth complications and traumatic events (head trauma from perinatal up to adolescence).

Cook suggested, "Genetics loads the gun and environment pulls the trigger."  The relationship between the Mom and Dad is a chronic source of stress for young children, such as arguing with each other.

A study of the effects of genetic risk and family functioning on eventual schizophrenia-spectrum disorders is telling.  In a study of adopted children, some had a genetic link, some did not have the risk of schizophrenia.  The incidence was dramatically larger in stress in family if there was an underlying biological component.

Cook repeated the prevailing wisdom, "The earlier you intervene, the better the prognosis."  If episodes increase, functioning appears to be lost and there's less recovery to be gained.  The goal is to reduce the duration of untreated illness to prevent an episode.

So how do we identify young people at ultra-high risk?  The Schedule of Prodromal Syndromes Scale (SPSS) lists these criteria:

• Delusions
• Grandiosity
• Perceptual abnormalities
• Hallucinations
• Disorganized communication
• Unusual thought content.

The other criteria are a family history of psychosis accompanied by a significant deterioration in functioning, and schizotypal personality disorder.

Early detection outreach involves education for pediatricians and mental health professionals, and for family doctors as well as for teachers and school counselors.  Early treatment with medication can stop psychotic symptoms, yet as noted by Cook and other psychiatrists I've interviewed, medications don't alleviate cognitive and social deterioration.

Psychosocial treatment involves family therapy to address family conflicts and foster low-stimulating environments.  Parents as advocates for their children can buffer internal stressors by adjusting expectations and giving reassurance.

The treatment package for early intervention includes a psychoeducational component, multifamily groups, case management using ACT principles and methods, supported employment and education, and a low-dose atypical antipsychotic medication.