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Preventing schizophrenia and psychotic behaviour: definitions and methodological issues
Stephen V Faraone1, C Hendricks Brown, Stephen J Glatt
1Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
Abstract:
Although schizophrenia onset usually occurs in late adolescence or early adulthood, much research shows that its seeds are planted early in life and that eventual onset occurs at the end of a neurodevelopmental process leading to aberrant brain functioning. This idea, along with the fact that current therapies are far from fully effective, suggests that preventive treatments may be needed to achieve an ideal outcome for schizophrenia patients and those predisposed to the disorder. In this article, we review the methodological challenges that must be overcome before effective preventive interventions can be created. Prevention studies will need to define the target population. This requires the identification of risk factors that will be useful in selecting at-risk people for preventive treatment. We review currently identified risk factors for schizophrenia: genes, psychosocial factors, pregnancy and delivery complications, and viruses. We also review 3 different types of prevention programs: universal, indicated, and selective. For schizophrenia, we distinguish prevention programs that target prodromal cases and those that target the disorder's premorbid precursors. Although those targeting prodromal cases provide a useful framework for early treatment of the disorder, studies of premorbid individuals are needed to design a truly preventive treatment.
Insights
Preventing schizophrenia requires identifying individuals at risk early in life. Research into genetic, environmental, and developmental factors is crucial for developing effective early interventions and treatments for schizophrenia.
Area of Science:
- Neuroscience
- Psychiatry
- Developmental Psychology
Background:
- Schizophrenia typically emerges in late adolescence or early adulthood.
- Onset is linked to a neurodevelopmental process with aberrant brain functioning.
- Current schizophrenia therapies are not fully effective, necessitating preventive strategies.
Purpose of the Study:
- To review methodological challenges in creating effective schizophrenia preventive interventions.
- To identify risk factors for selecting at-risk populations for prevention.
- To discuss different types of prevention programs for schizophrenia.
Main Methods:
- Review of identified schizophrenia risk factors: genetic, psychosocial, perinatal complications, and viral infections.
- Analysis of universal, indicated, and selective prevention program types.
- Distinguishing between prevention targeting prodromal cases and premorbid precursors.
Main Results:
- Effective prevention requires defining target populations through risk factor identification.
- Several risk factors are known, including genes, psychosocial elements, and perinatal issues.
- Prevention strategies must differentiate between targeting early symptoms and addressing premorbid stages.
Conclusions:
- Truly preventive treatments for schizophrenia necessitate studies focusing on premorbid individuals.
- Targeting prodromal cases aids early treatment but is not sufficient for primary prevention.
- Overcoming methodological challenges is key to developing successful schizophrenia prevention.