July 18, 2006

Drugs Before Schizophrenia Diagnosis?

An excellent story in June's Time Magazine (Australian Edition) about early treatment of schizophrenia (via drugs, as well as other approaches). The story covers the research that is going on in this area - with a focus on Dr. Patrick McGorry - a leader in the field who is based in Australia.

At schizophrenia.com, we believe that the potential benefits of this type of research are great - and we need to explore all avenues (drug and non-drug) for schizophrenia prevention. Moreover, we need to do this with a much higher level of investment than we have been.

Experiments, by definition, are a voyage into the unknown. But Melbourne psychiatrist Patrick McGorry conducted one on young people in the late 1990s that was more daring than most. McGorry was tantalized by the idea that psychotic disorders such as schizophrenia have a pre-onset phase, or prodrome, during which careful intervention could prevent them from emerging—and wrecking the lives of sufferers and their loved ones. The theory wasn't McGorry's alone, but he decided to test it in a world-first trial that had psychiatry's skeptics aghast.

The point of contention was that some 30 subjects in McGorry's trial received as part of their treatment regular doses of risperidone, one of a class of drugs known as antipsychotics or neuroleptics, which have been linked to a host of harmful side effects, including movement disorders. Critics were indignant that a potentially dangerous drug was being used on a hunch, and suspected the influence of big pharma and its drive to expand its markets. "This," American mental health lobbyist David Oaks told Time in 2001, "is one of the most bizarre and counterproductive human experiments on young people I know about."

...Calm and softly spoken, McGorry has a way of making the experimental use of antipsychotics seem like the only responsible course. As executive director of the University of Melbourne–affiliated Orygen Youth Health, he sees patients aged 15 to 24 whose symptoms may include mild paranoia and social impairment. Fish oil and cognitive behavioral therapy (CBT) are sound first-up treatments, he says, but if they don't work it's unacceptable to wait for patients to slide into madness, though it's impossible to predict with certainty which ones will. "You've got to do something," McGorry says, meaning consider adding a neuroleptic drug to the treatment mix."

Read the Full story: Drugs Before Diagnosis? An Australian psychiatrist defends medicating troubled adolescents to help prevent schizophrenia

Related Reading:

Mixed Results for Early Schizophrenia Treatment with Antipsychotic Meds


_Lots of kids are getting anti-psychotics in the US too.I guess we can expect a huge decrease in SZ cases in coming years?

“What was most striking is that nearly one in five — 18 percent — of visits to psychiatrists by young people resulted in their being prescribed an antipsychotic medication,” lead investigator Dr. Mark Olfson told Reuters Health Approximately 90 percent of antipsychotics prescribed were for the second-generation drugs — clozapine, risperidone, olanzapine, and quetiapine. None of these drugs are approved for treating adolescents or children.

The researchers note that these drugs were prescribed primarily for disruptive behavior disorders (37.8 percent), mood disorders (31.8 percent), or pervasive developmental disorders or mental retardation (17.3 percent). Only 14.2 percent were prescribed for psychotic disorders."

Posted by: symptomatic at July 18, 2006 08:25 PM


We're talking about research here in the story above - in the US perhaps 50 to 100 people have been involved in early schizophrenia prevention studies. We think that prevention of schizophrenia is a good thing - so we support these efforts.

But, at the same time I can sense your skepticism and thats a valid approach too.

Posted by: szadmin at July 18, 2006 09:44 PM

It is something of a catch 22 situation.Evidence shows that the longer the illness is present before the sufferer is prescribed
medication the worse things tend to be.
However it could be described as ethically wrong to prescribe medication for an illness that may or may not manifest itself at some future date.

Hopefully research will lead to a more accurate means of targetting those within 'high risk' groups who will progress to developing schizophrenia and for whom treatment before overt manifestation of the illness makes sense.

Posted by: Tim at July 19, 2006 03:58 AM

The trouble with schizophrenia is that 'prodrome is a retrospective concept', in other words, the early signs of the illness are very vague, and at that early point, don't indicate anything specific. Later, when the person becomes obviously ill those vague signs obviously start to seem significant. But when they occur, they aren't clearly pointing to schizophrenia.

One researcher did a project in which she reviewed family films made of toddlers and infants years or even decades before they became obviously ill. She found clear, obvious neurological problems - problems crawling, reaching, gazing. Perhaps someday that kind of thing will be a part of early detection of schizophrenia.


Posted by: slc2 at July 21, 2006 09:28 AM

also, something else i remembered. many youngsters get medications like risperdal for conditions that are not psychotic disorders. these medications are used for a very wide group of related conditions, from autism, to obsessive compulsive disorder to tourette's syndrome. since antipsychotics are general medications they actually are useful for a broad variety of related conditions. i have seen very misleading articles that state that too these children are being 'treated for psychosis' - they aren't. it's just that antipsychotics really aren't 'antipsychotic'. they balance brain chemistry activity, so actually can help with a large variety of neurological disorders.

Posted by: slc at July 21, 2006 09:32 AM

i keep thinking of more things, LOL. the last item is that most of my schizophrenic friends had symptoms, clearly, obviously psychotic symptoms - heard voices, saw hallucinations - since very young childhood. When they tried to tell someone that - they were told it wasn't happening, was their imagination, it isn't important, etc. i do think that children who have frank psychotic symptoms can benefit from small amounts of medication.

Posted by: slc2 at July 21, 2006 10:06 AM

What is worrying is these anti-psychotics are NOT APPROVED by FDA/other regulators for treating children or adolescents.
children sufferring from IED, distruptive disorder used to be called TEMPER TANTRUMS and a good wallop in the buttock used to treat them may be 50 years back.Now this will be called child abuse but giving them un approved medications are fine as it suits the drug MNCS.

Posted by: captainjohann at July 25, 2006 02:26 AM

Post a comment

Please enter this code to enable your comment -
Remember Me?
(you may use HTML tags for style)
* indicates required