Early detection, intervention for schizophrenia: Progress report

"There is now a consensus that if we can identify people early in the course of the illness, or even before the illness starts, there will be a better chance to improve outcomes," comments guest editor Faith Dickerson, PhD, MPH, of Sheppard Pratt Health System, Baltimore.

Can Psychosis Be Detected and Treated Early?

"If we cannot cure schizophrenia, at least we can improve the quality of life and lower the rate of premature deaths," Dr. Dickerson adds. "There is now an imperative to do so."

The special issue includes 13 articles contributed by preeminent researchers in the rapidly evolving field of early intervention for psychosis. A major focus is on the early symptoms, or "prodrome," that may predict the development of schizophrenia or other psychotic disorders.

In the lead article, Patrick D. McGorry, MD, PhD, shares his personal perspective on three decades in early intervention research and practice. He believes that early intervention is an "obvious, effective, and overdue" approach to overcoming the historically pessimistic, even hopeless, outlook for patients with schizophrenia and psychotic disorders. Dr. McGorry envisions a worldwide movement toward early intervention -- not just for psychosis, but for all mental disorders.

The special issue also includes an article by William T. Carpenter, MD, who has outlined a proposed diagnostic category -- attenuated psychosis syndrome (APS) -- to identify patients at high risk of developing psychotic disorders. The need for this new category continues to be "hotly debated." But Dr. Carpenter believes it will help in providing treatment for possible early symptoms of psychosis -- especially in younger patients -- and provide new information on how psychosis develops.

Jean Addington, PhD, and colleagues report on a large study of young patients at high risk of psychosis -- most of whom met the criteria for APS. When followed over two years, the patients as a group had an improvement in symptoms and only a minority progressed to a psychotic disorder. The study identifies key patient characteristics associated with a higher risk of progressing to psychosis.

Other research focuses on how psychosis develops, along with the potential to identify new treatments to affect its course. Natalya S. Weber, MD, MPH, and colleagues performed a unique study of military personnel, taking advantage of the blood samples obtained from all recruits. They found that subjects with low levels of pentraxin-3 -- a protein involved in immune and inflammatory responses -- were three times more likely to develop schizophrenia than matched controls.

That study adds to emerging evidence that the immune system and inflammation play a role in the development of schizophrenia, raising the possibility that "immune modulatory" agents could be effective early treatments. Other studies in the special issue focus on the treatment and outcomes of initial episodes of psychosis. These reports come at a time when dedicated treatment programs for such "first-episode patients" are being developed and disseminated.

The editor and contributors hope their efforts will help sustain the momentum toward early recognition and treatment of patients at risk of developing psychosis. Dr. Dickerson concludes, "Clearly, there is now urgency to improve outcomes for patients with schizophrenia starting early in the illness or even before the illness begins, to cast a wider net in identifying vulnerable individuals, and to provide specialized services for high-risk and for early-onset patients."

The special journal edition can be found online at: http://journals.lww.com/jonmd/toc/2015/05000