Treating Pre-psychosis

The Boston Globe has an article on the detection and treatment of pre-psychosis bearing the heading Getting ahead of trouble.

Only 0.5 percent to 1.5 percent of the general population has schizophrenia, but studies conducted in the late 1990s and early 2000s found that some 40 percent of patients diagnosed with psychosis risk syndrome went on to develop a full-fledged psychotic disorder, such as schizophrenia, within 6 to 12 months.

40% of pre-psychotic cases then develop into full-blown psychosis within a half a year to a full years time. Good thing we caught them then, huh? No telling how many pre-psychotics are wandering around loose out there now. The statistics we don’t have here? What percentage of undiagnosed pre-psychotics develop into full-blown psychotics.

But the suggestion has proven to be controversial, partly because most patients with the syndrome will never develop an official psychotic disorder. Over the last 10 years, the percentage of people who have transitioned from the risk syndrome to full-blown psychosis — the so-called conversion rate — has dropped from 40 percent to 27 percent or even lower, by some accounts.

Uh, but we still have to protect vulnerable members of the general public from pre-psychotic people, don’t we?

The issue of false positives is immense, says [Dr. Oliver] Freudenreich. “There’s an enormous concern in the US that we are already using a lot of antipsychotics in children,’’ he says.

Use of these drugs is growing. In 1995, 8.6 out of every 1,000 children ages 2 to 18 were on some type of antipsychotic medication. By 2002, that number had risen to 39.4 children out of every 1,000, according to a 2006 study by researchers at Vanderbilt University.

One little draw back to consider here is that the pre-psychosis diagnosis is not going to diminish the number of children on neuroleptic drugs, if anything it is likely to increase that number. I imagine the notion of having schizophrenia is a lot easier for a person to digest once that person has already digested the notion of having pre-schizophrenia.

Naturally enough this leads to my next question. Could it be that some of our prevention efforts serve not so much as prevention efforts as they do catalysts for the spread of “disease”?