Research Focus on Early Intervention and Detection

Schizophrenia and other psychotic disorders are devastating illnesses affecting approximately 3% of the world population. Onset typically occurs during late adolescence or early adulthood, a critical period of development during which young people become independent from their parents, complete their education, and embark upon productive career paths. However, individuals who develop schizophrenia and other psychotic disorders frequently become unable to continue with their education or employment. Instead, they are often chronically socially and occupationally disabled, and require repeated hospitalizations due to the disorders often unremitting or relapsing course. Thus, psychotic disorders represent a human tragedy of staggering proportions for patients, their families, and society. However, precious little is known about how or why psychotic disorders develop, primarily because most research in this area is conducted on individuals with established illness, in whom the pathophysiological processes have to a large extent already run their course. As a consequence, available treatments are reactive rather than proactive, palliative rather than curative or preventive.

In parallel with other chronic physical illnesses, such as diabetes and heart disease, the scientific focus has shifted to early intervention and prevention. In the field of psychosis, this focus has generated an interest in the prodromal phase of the illness, the stage just prior to florid psychosis. Subtle pre-illness clinical, psychosocial and cognitive deficits have been reported for many years. But it is only in the past decade that systematic, reliable identification of "prodromal" individuals has become possible, based on the presence of subthreshold psychotic symptoms and/or a family history of schizophrenia with signs of functional deterioration. These individuals who appear to be in a prodromal phase of schizophrenia or other psychotic illnesses have high rates of conversion to psychosis (ranging from 15-35% in most studies) over about two years. In the prodromal phase the formation of symptoms and disability has already begun. Many of these individuals are help-seeking since their symptoms, although attenuated or subthreshold for psychosis, are already debilitating.

Interestingly it is not only psychotic illness that begins in adolescence and early adulthood but is the time when the majority of mental illness begins. Thus, our most recent research project is focusing on youth at risk of mental illness not limited to just psychosis.