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February 23, 2005
The Need for Early Intervention
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The Need for Early Intervention in Schizophrenia
A Schizophrenia.com Editorial by Marvin Ross
"Once the damage is done, it cannot be undone. Neither love nor money can ever undo the damage of delayed treatment for schizophrenia. The individual is disabled for the rest of his or her life and this is what early intervention can prevent."
These words were spoken by a man whose own diagnosis and treatment were delayed for over ten years and whose life today would have been considerably different if he had been treated early. In addition to the human cost, the cost to society would have been much less.
He went on to say that "it is only too self-evident to me that I have permanent damage that I must live with because I was not treated in the first six months. It is something that I think about everyday, something I have to reaccept every morning".
And it's not as if early intervention and prevention are foreign words in health care. We are continually being bombarded in the media with messages on the need to monitor our blood pressure and cholesterol in order to prevent heart attacks and stroke. We are continually being told about the value of early detection and the need to do breast self- exams and to have mammograms, or to have colonoscopies every five years for those over 50 or to get PSA levels checked.
But when it comes to schizophrenia and other serious mental disorders, that message is absent or only spoken by a few. Certainly, the funding for these initiatives is minimal.
Beside the horrendous cost to individuals and their families from this disease, there is an enormous cost of untreated or inadequately treated schizophrenia to society. A Canadian study found that the total cost of schizophrenia to Canadian society was $2.35 Billion in 1996. As the US is about ten times the population of Canada, we can estimate that the US cost is probably around $25 Billion a year.
Early identification is becoming more accurate for those at high risk. One study conducted in Melbourne and reported in Schizophrenia Research (April 2004), followed 104 young people with a family history of psychotic disorder combined with some functional decline or the presence of sub threshold or self-limiting psychotic symptoms. All were symptomatic but not psychotic.
A third of them developed psychotic symptoms within 12 months and this was predicted with very high accuracy based on the duration of their initial symptoms, poor functioning, high levels of depression and reduced attention. Also predictive of psychosis were a family history of psychosis, a recent significant decrease in functioning and a recent experience of sub threshold psychotic symptoms.
The British Journal of Psychiatry published a Scottish study in January 2005 on a simple test that can be given to those at high risk that can also help predict who will develop schizophrenia. The test, which measures IQ, memory, motor skills and verbal learning, was administered to 163 people aged 16-24 with a family history of schizophrenia. They also had brain scans.
45% of the group showed symptoms of schizophrenia but only 12% went on to become sick. The researchers were able to predict with high accuracy who would become ill up to three years before they actually did become sick.
Let us go back to the person in our quote at the start of this editorial. He, like so many others, has permanent damage because of the delayed identification and treatment for his schizophrenia. The Canadian consensus guidelines developed by psychiatric specialists from across Canada based on the best scientific evidence to date state "evidence indicates there may be long-term benefits when effective treatment of schizophrenia is started as early as possible in the illness".
In fact, the evidence implies that intervention early in the development of psychosis may lead to complete or almost complete recovery in a much larger proportion of patients than is currently the case and that there is evidence to demonstrate that untreated psychosis may have a negative impact on the functioning of the brain but that first episode patients may be much more responsive to drugs than they would be later in the illness and even require lower doses.
Early intervention for those at risk can help to predict who can be treated early so as to minimize the impact of the disease and to help them carry on as near normal lives as possible. Work is being done on other predictors but much more needs to be done and more funding is required from governments.
It is just as important to help identify early the potential onset of schizophrenia as it is to identify early hypertension, breast cancer, prostate cancer and colon cancer. Our young people deserve it and should expect it.
Posted by szadmin at February 23, 2005 05:26 PM
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