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”?

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7 Responses

  1. If a person has a problem it can become less of a problem, stay about the same or become more of a problem. You don’t have to be a psychiatrist to figure that a big problem is often something that has developed over a period of time. Actually a psychiatrist is less likely than your grandmother to understand this. Unless your grandmother is a psychiatrist, in which case you’re screwed.

    • I was going to end the piece above differently…

      A review of the data in other studies suggest to researchers 8% – 35% of ADHD cases phony.Think about it this way, we are out to catch people with a predisposition to develop a “mental illness” before they develop that “mental illness”. Theory has it that this predisposition pertains to a certain percentile of the population. Theory has it this developing of “mental disorder” has something to do with genetic make up. If, given enough abuse, hardship, and torture, anyone could lose their mind, then predisposition rises to 100%. If 100% of the population were predisposed to develop schizophrenia, given the right external environment, of course, then 100% of the population is pre-psychotic.

      Alright, indeed, some people might die before they broke under abuse, hardship, and torture. I need to modify this thing a bit. When the people who survived the abuse, hardship, and torture long enough to crack up are factored in, I imagine it would be way up there in the 80 – 90 % categories anyway. I think ethical considerations would probably prevent us from getting to the bottom of this thing. Yes, but army intelligence has probably already been there, and if you ask them, don’t expect the answers to ever be de-classified.

  2. As far as I know, antipsychotics don’t work to prevent psychosis in at-risk people, so the entire idea of treating the problem before it becomes too big, false positives aside, is rather moot.

    • We’ve got a growing problem right now, and I hardly think this diagnosing of potential head cases is going to shrink the problem. Preventive care in my mind means doing something about those social conditions that lead to desparate situations. Do something about the trickle down economics that led to so much homelessness in the world and nation, and you’ve done a whole lot to relieve the mental suffering a heck of a lot of people are experiencing right now. Give people a place to lay their heads, and get some shut eye, give them a refuge from abusive family situations, and I would think those same people would be less likely to wind up in the looney bin, too. The problem is about people under valuing people. You treat people poorly, and poor outcomes pop up here, there, and the other place.

  3. […] 8, 2010 by Astrid The author of Lunatic Fringe has an interesting post on treating pre-psychosis. Psychosis risk syndrome, which is proposed for inclusion in DSM-V under the name of attenuated […]

  4. Oh… yeah, and of course the idea of preventative diagnoses will work hand in hand with the efforts to “reduce the stigma”.

    • A lot of people are “in recovery”. Much fewer have actually recovered. I don’t think these future disorder diagnoses are going to help people overcome the stigma attached to fully recovering their mental health. The stigma against full recovery of mental health, that’s the one we need to work on.

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