World Congress of Psychiatry Report on Schizophrenia and Youth
Teen-agers who withdraw from friends, act strangely and start getting low grades in school may not be rebels without a cause -- they could be showing early symptoms of schizophrenia.
Since film legend James Dean immortalized the anguished teen-ager in the 1950s, parents have taken it for granted that adolescents go through a period of feeling misunderstood during which they sometimes become anti-social and defy authority.
"That is often used as an excuse for not actually carefully looking at what kind of problems are going on," Professor Patrick McGorry, an expert in schizophrenia, told a meeting at the World Congress of Psychiatry in Madrid. "Often the more non-specific things which you do see in adolescence can be the very first signs of psychotic illness," said McGorry, of the Early Psychosis Prevention and Intervention Center (EPPIC) in Melbourne, Australia.
Schizophrenia is a mental illness which affects one person in 100 before the age of 45 and mainly strikes young people. Acute schizophrenics lose touch with reality and suffer from hallucinations and paranoia, which cut them off from the rest of the world and trigger intense anxiety and depression. They begin to avoid social contact and their mental faculties become blunted until they find themselves unable to perform even small daily tasks. The precise causes of schizophrenia are unknown and, until now, its treatment has focused on patients in advanced stages of the illness.
The EPPIC is trying to change that by educating general practitioners (GPs) and school counsellors to recognize early warning signs so youngsters can be helped before they develop full-blown psychotic symptoms. Teen-agers who have had no previous problems and suddenly become withdrawn or develop serious problems relating to their peers are among those who should be referred. "One of the big problems with the treatment of schizophrenia is that (doctors) have really only started to treat people when the illness has become extremely established," said McGorry. "It's as if cancer services or diabetes services refused to see anybody until they got to a very serious stage of the illness."
Even when a person has become psychotic -- the stage at which they have hallucinations or delusions -- there is an average of about one year's delay in getting treatment in many countries, sometimes longer, McGorry said. "GPs are notoriously poor at picking up psychological problems, even more obvious ones such as depression," he added.
"But things are really changing very fast at the moment. The idea that we can intervene early and significantly improve the outcomes for young people...is really taking root now." The problem is in informing parents and teachers without causing undue alarm. For instance, a sudden drop in school grades can be due to any number of factors and is only useful as a screening indicator.
McGorry and his colleagues have set up the Personal Assistance and Crisis Evaluation (PACE) service, a clinic where young people with problems can be evaluated without suffering from the stigma linked with psychiatric clinics. Because the approach is new, doctors are still not sure what the best form of preventive treatment is: psychological counselling, low-dose drug treatment or a combination of both.
Meanwhile, other researchers are looking back to childhood to try to pinpoint what sets future schizophrenics apart, in the hope that one day they will be able to predict the disease. Traveling back in time, they analyze school and health records and even home movies for signs of abnormal behavior.
So far, they have found that pre-schizophrenics -- along with other children who later develop some sort of emotional or neurotic illness -- are slower in learning how to walk and talk and have a lower I.Q. than other children their age. But it is their social behavior that really set these toddlers apart. One study found that children aged four and six who later became schizophrenic were more than twice as likely to prefer playing by themselves than others their age.
Professor Elaine Walker, of the Emory University of Psychology in Atlanta, Ga., studied childhood home movies and found that these babies were also more likely to have negative facial expressions and move their limbs in abnormal ways.
But she stressed that home movies were far from being a reliable way
of predicting schizophrenia. "As a diagnostic tool, it's very far
away," Walker told Reuters. "There might be a point in the future
where you can identify individuals at risk and induct physiological tests."
Will doctors one day be able to identify young children as future schizophrenics
and prevent the onset of the disease through drugs? "That is not out
of the question," Walker said, but added: "It is probably far
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