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 the
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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