Early help for individuals at risk for psychotic illness
Treating people at risk for psychosis may reduce the devastating effects of mental illness.
Story by Julie Sedivy/Illustration by Genevieve Simms
Schizophrenia is a mental disorder characterized by disorganized thinking, delusions, or hallucinations. People with schizophrenia can find it difficult to tell the difference between real and unreal experiences. A condition known as psychosis occurs when patients completely lose contact with reality. If psychosis is left untreated, patients can sometimes harm themselves or others.
However, very few patients with schizophrenia are violent. Nevertheless, the illness is often devastating to patients and their family members, especially if it progresses to full psychosis. Dr. Jean Addington, a professor in the Department of Psychiatry at the University of Calgary, believes that much of this suffering can be prevented if the illness is treated early. She is involved in a large-scale international study to better identify and treat pre-psychotic individuals who are at risk of developing psychosis.
Those who are in a prodromal (pre-psychotic) state are usually already experiencing some difficulties in functioning. They may be depressed or anxious and struggle to maintain motivation. They often have unusual thought patterns: they may have a vague sense of disconnection from the world or may think that others are talking about or watching them. They may also have occasional disturbances of perception, seeing fleeting images in their peripheral vision or experiencing changes in their smell or taste. But they usually recognize that these thoughts or perceptions don’t reflect reality. However, if patients progress to a psychotic state, they lose the ability to objectively separate these delusions and hallucinations from fact.
Dr. Addington estimates that about a third of patients in the prodromal state would improve without intervention; another third would remain in a sustained state of diminished functioning; and the remainder would deteriorate into psychosis. To better understand which patients are likely to experience full-blown psychosis, Dr. Addington leads a group of students and colleagues at the University of Calgary who are collaborating with seven other research institutions in the North American Prodrome Longitudinal Study (NAPLS). The study will evaluate a wide range of risk factors including genetic vulnerability, traumatic events, and abnormalities in cognitive functioning and brain activity. The goal of NAPLS is to develop predictive measures for psychosis and, eventually, to provide clinicians with a set of tools that will improve their ability to identify those who are most at risk.
The impact of early identification of prodromal patients could be immense. Early identification increases the likelihood that patients will accept treatment in the first place. Once the illness has advanced to a psychotic stage, it can be very difficult to convince patients to get help. Ironically, typical symptoms of psychosis such as paranoia and distrust can make people reluctant to seek and receive treatment when they need it most. By learning how to manage their symptoms early on, individuals could also reduce the disruption their illness has on their lives and those around them. Dr. Addington believes that such advantages make it that much more important to offer early treatment to individuals because they are still able to understand that their experiences are the result of mental illness.
Although Dr. Addington’s team has two full-time members recruiting volunteers for the NAPLS study, she estimates that she is still only able to identify about one in 20 people at risk for psychosis. One of her main goals is to understand what prevents those who are at risk from seeking help. Dr. Addington emphasizes that treatment can be beneficial for all patients—even for the third of people whose pre-psychosis state would not progress into full psychosis if left untreated. She points out that, in many cases, patients already experience a significant decrease in quality of life and need additional support to reach their full potential. She notes that the scientific thinking about psychosis has shifted considerably: “Previously, it was thought that you either had schizophrenia or you didn’t. But now we know that these experiences and symptoms really fall on a continuum.”
Quick facts
The onset of schizophrenia typically occurs during adolescence or early adulthood.
Source: Schizophrenia Society of Canada