Global Effort Paying Dividends

A bold effort is under way throughout the world to understand better the earliest signs of schizophrenia, use that information to treat young people developing the disorder, and see whether treating youth showing early signs of the illness might even halt or prevent it (see story above).

Although this effort is laudatory in principle and is leading to some positive clinical benefits, it raises some ethical questions for which, at least at this time, there are no clear answers.

For example, scientists can predict much better today than they could a few years ago which young people showing warning signs of schizophrenia will actually develop it, Delores Malaspina, M.D., a professor of clinical psychiatry at Columbia University, told Psychiatric News. But the effort is far from perfect. “Over half the young people identified as prodromal probably will never develop schizophrenia,” she said. In fact, evidence reported in the January British Journal of Psychiatry supports this conclusion. That study was conducted by Eve Johnstone, M.D., a professor of psychiatry at the University of Edinburgh in Scotland, and colleagues.

So, should scientists use antipsychotic medications to treat young people showing signs of schizophrenia when there is a chance that they will never develop the illness? Some psychiatrists are for it, some against, Malaspina said.

What about the issue of stigma for youth who receive early intervention? Certainly it could stigmatize them, Cheryl Corcoran, M.D., an assistant professor of clinical psychiatry at Columbia University and co-workers noted in an article in press with Schizophrenia Research. “The idea of being at risk for psychosis might affect an individual's choices in terms of education, employment, or other life plans. It might impact the extent to which such plans and aspirations would be supported by other family members.”

And should clinical psychiatrists be offering treatment to youth who show possible early indications of schizophrenia? Malaspina has her doubts. Nonetheless, she said, a number of psychiatrists are doing so. “What I think has happened,” she said, “is that the clinical community, seeing that the research community wants to prevent the illness, has jumped right in. This intervention is very well intentioned. [But] the clinical world has gotten ahead of the research knowledge.”