Treating early signs of schizophrenia advised

Benefits seen in medicating before `first break,' but some professionals urge caution

May 01, 2006|By JAMIE TALAN

Scientists call it "psychosis in miniature" and have completed a study that suggests that treating young people with the earliest signs of schizophrenia may prevent or push back the mind-altering condition.

But the study, published in the latest issue of the American Journal of Psychiatry, raises concern from some in the field about whether schizophrenia can be identified so early. The most severe form of mental illness, schizophrenia affects one in every 100 people.

"While it would be great to find people at risk, you don't want to put people on these medicines if they don't need to be," said Dr. Daniel Weinberger, director of genes, cognition and psychosis at the National Institute of Mental Health.

The anti-psychotic medicines have been linked to weight gain, type-2 diabetes and cognitive problems. "There is a lot of concern in the field," Weinberger said.

But Dr. Thomas McGlashan, a professor of psychiatry at Yale School of Medicine and principal investigator of the new study, said that it's time to figure out whether doctors can pick out affected young people before their "first break," which is marked by hallucinations or delusions and can be traumatic for patients and their families.

The people recruited for his study - most of them adolescents - had not lost their grip on reality but said they knew what they were thinking was not right, McGlashan said. The scientists found 60 young people with what they thought were early signs of altered thinking and assigned them to an anti-psychotic medication or a placebo for a year, and then watched them for another year.

McGlashan and his colleagues found that 38 percent of those on a placebo developed psychosis - delusional thinking or hallucinations - compared with 16 percent of those taking olanzapine, made by Eli Lilly & Co. McGlashan agrees that it's important to figure out who these young people really are - and that is precisely why these studies need to be done.

"I do see this as a proof of concept," McGlashan said. "There really is this high-risk state, or syndrome, that you can detect. The treatment made a difference."

When signs of psychosis developed during the first year of the study, the person was treated with olanzapine.

"We don't have enough data to say, `Start writing prescriptions,'" he said. "If a parent is worried, have your child evaluated and followed" by a psychiatrist. Then, if the young person develops psychosis, he or she will be in treatment.

Researchers at Long Island Jewish Medical Center have also been trying to identify these at-risk patients and offer early treatment. In another important schizophrenia study, Dr. Anil Malhotra, director of psychiatric research at the Long Island center's Zucker Hillside Hospital, has identified strong evidence that a gene called dysbindin, recently implicated in schizophrenia, has a direct effect on cognitive ability.

About 12 percent of people with schizophrenia have this particular form of the dysbindin gene. Malhotra says there is evidence that the risk gene disrupts the function of an excitory brain chemical called glutamate. This form of the gene is also found in 7 percent of people without schizophrenia.

Jamie Talan writes for Newsday.

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