Schizophrenia: The Rationale for Early Detection and Intervention
Orna Guralnik, Psy.D.
Schizophrenia is generally considered to result from a combination of environmental
stress and an inborn vulnerability to psychosis. It is usually expressed
in late adolescence as manifested in cognitive and social impairments. The
presence of a deficit process has been clearly demonstrated at the onset
of positive symptoms of schizophrenia, however when and whether these deficit
processes are present in the prodromal phase is unclear. Neuropsychologic
tests are the current best measures of these deficits.
Thomas H. McGlashan, MD, from New Haven, Conn. summarized studies that documented
existence of mild cognitive deficits before the onset of acute positive
symptoms as well as a more severe decline in functioning around the time
of onset. The deficits are often irreversible, leading investigators to
suspect that the process that makes schizophrenia chronic may be most active
early in its course. It is still possible that deficits could reflect impairments
that are secondary to brain hardware changes involved in the onset of illness.
Dr. McGlashan also reviewed clinical research which suggests that known
treatments applied early enough may reduce the negative impact of the deficit
processes on prognosis. Schizophrenia has become milder, by clinical description,
during the 20th century, probably primarily due to improved treatments,
including psychosocial. The introduction of neuroleptics such as clorpromazine
has changed the picture of the schizophrenic illness drastically.
Accumulating evidence in the literature documents that early intervention
leads to better prognosis. For example, in 1 study of first-episode schizophrenics
conducted at Hillside Hospital in New York, extensive delay periods were
documented between the onset of prodromal symptoms and the onset of illness
(average, 3 years) and between the onset of positive symptoms and first
treatment (average, 1 year). Results showed that the longer the delay, the
longer time it took patients to remit, and the less complete their remission.
Dr. McGlashan also discussed Dr. Ian Falloon's early intervention project
(see "Detection and Early Intervention in the Prodromal Phase of Schizophrenic
Disorders" ), which further supported the importance and validity of
prevention and the benefits of early intervention. Dr. McGlashan warned
against the common "wait and see" attitude, common in the first
episode of schizophrenia, stating that such caution is deleterious, at best
and actively pathogenic, at worst.
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