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Importance of Prevention and Early Detection

About a decade ago I went through one of those moments that left me feeling, well, unprepared.  It was a situation where I should have been thinking about a problem way before it ever happened.   At hand were issues of early detection, prevention of illness, and trying to stay ahead of a potentially difficult problem.

My wife was pregnant with our third child.  She and the soon-to-be baby were undergoing a bunch of tests for various genetic disorders.  While we were waiting for the results, my wife suggested that we talk about what we would do if the tests came back positive. I didn’t have to say a word for her to realize, by my expression, that I hadn’t really thought about this question.  I had no plan.

Having a plan when someone is identified at high risk for a mental health disorder is critical.  Some of our best medical researchers are helping us learn to identify people at high risk for mental health problems from alcohol addiction to schizophrenia.  The thinking behind this research is easy enough.  If you identify something early, you have a better chance of doing something to stop it altogether, or to minimize its impact on your life.  At the very least, identifying a mental health problem early allows you to proceed with your eyes wide open.

The research on early detection of schizophrenia is fascinating.  Schizophrenia is usually first fully evident during late adolescence or early adulthood.  However, we know that genetics play a role in schizophrenia, and many psychiatric disorders.  For example, research shows that there is a higher incidence of schizophrenia in first degree relatives of people with schizophrenia.  The risk for schizophrenia increases when people have the same genetic makeup, like an identical twin.

The genetic underpinnings of schizophrenia are present long before we realize a person has the disorder – that is, at birth. Since we don’t know the precise genetic code for schizophrenia (if there is one), are there any early clues that might help with early detection?

Our ability to reliably identify very early signs of risk for schizophrenia is limited.  Some early, preliminary findings include:

Evidence of a modest decline in IQ scores in people who have schizophrenia that occurs long before the formal onset of the disorder.
Evidence of loss of brain function in areas responsible for accurately understanding social situations during the period of time immediately before the formal onset of the disorder.
It will be many years before this research matures to the point where people at high risk for schizophrenia can be identified many years before the onset of the disorder.  However, progress is being made in detecting schizophrenia in the year or two prior to its formal onset, a time termed the prodromal phase of the illness.  Detailed interviews with adolescents or young adults that focus on things like high levels of supiciousness/paranoia, odd or unusual thinking, and a downward trend in school or social functioning, can identify people at highest risk for schizophrenia in 65-80% of people. 

So, suppose that a person is identified as at high risk for schizophrenia.  Is there a plan?  Or, are we left without any direction, unprepared like I was after our genetic tests for our baby?

We know some elements of a good plan.  Seeing a qualified mental health professional, like a psychologist, psychiatrist, psychiatric nurse, or licensed social worker is a good start.  Supportive counseling, even if not specific to schizophrenia, appears to have some positive effect.  Certain types of medication, often in low doses, are effective in helping people identified at high risk for schizophrenia to function better at school, home, or work.  And, more focused types of counseling, such as those combining social adjustment skills and cognitive therapy, have lasting benefit.

It is never pleasant to hear that someone you care about is at high risk for a physical or psychiatric disorder.  But, if you do hear that news, it helps to know you can make a plan