Schizophrenia is one of the most severe forms of mental illness. Symptoms of the disease include hallucinations, delusions, and disorganized thought and speech patterns, according to the Child Mind Institute.
How — and When — Does Schizophrenia Start?
The onset of schizophrenia is usually during the teen years or early adulthood, according to the National Institute of Mental Health (NIMH). The disorder is extremely rare in childhood, however, experts are homing in on early warning signs of the disease in an effort to diagnosis schizophrenia early and launch treatment.
Looking for Early Warning Signs of Disease
Newer research suggests that cognitive impairment and unusual behaviors can appear in childhood or adolescence. In adolescents, the first signs of the illness are often subtle, such as withdrawal and isolation. While a diagnosis of schizophrenia is typically not made until the first psychotic break, healthcare professionals have refocused the field on early detection and early treatment.
Getting Young People Into Treatment
According to the Child Mind Institute, about 100,000 teens or young adults in the United States experience a first episode of psychosis each year. “The whole idea in the field is to figure out how to intervene earlier,” says Ken Duckworth, MD, medical director for the National Alliance on Mental Illness (NAMI) and an assistant clinical professor at Harvard University Medical School in Boston. “Finding a way to get a younger person into treatment is important because the sooner they get into care, the better their outcomes is likely to be.”
The Timing of Schizophrenia Disease Onset
Schizophrenia is particularly devastating because it often occurs at a key time of life when adolescents or young adults are honing their identities and making decisions about careers, education, and relationships, Dr. Duckworth says. “That is one of the great challenges. Schizophrenia attacks cognition, emotion, and behavior while they are trying to establish their own identity,” he says.
Risk Factors May Offer Early Clues to Severe Mental Illness
Experts are trying to find better ways to recognize the early signs of schizophrenia, Duckworth says. A major study funded by NIMH, called North American Prodrome Longitudinal Study (NAPLS), is underway to try to identify youth at risk for developing psychosis and understand the risk factors and symptoms (called prodromal symptoms) that may precipitate psychosis.
Understanding Prodrome Syndrome, a Precursor to Schizophrenia
“The prodromal syndrome is essentially a syndrome that leads up to the full-blown psychosis,” says Nitin Gogtay, MD, director of the Office of Clinical Research at the National Institute of Mental Health (NIMH). “It’s a precursor. It doesn’t always go to full-blown schizophrenia, but it consists of early signs and symptoms that could potentially lead to schizophrenia.” While early diagnosis is preferable, doctors must be careful about making a diagnosis of schizophrenia too soon, Dr. Gogtay says.
Many Other Health Conditions Must Be Ruled Out
“It’s really important to be cautious about it because most of the time these symptoms don’t necessarily mean schizophrenia,” he says. “There are other reasons: anxiety or depression or behavior issues. Those need to be carefully ruled out.”
Efforts Are Underway to Treat Schizophrenia Early
When properly diagnosed, early treatment is considered essential, Duckworth says. Earlier treatment is already becoming a reality across the country. The NIMH has launched a program called Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP), which emphasizes state-of-the-art medication and psychosocial treatments, delivered by trained multidisciplinary teams, to improve the outcomes and quality of life for patients after the first episode of psychosis, according to research published in the Journal of Clinical Psychiatry. Initial treatment typically includes inpatient hospitalization with medication therapy. After discharge, treatment usually consists of prescribed medication, cognitive behavioral therapy, family support and education, and other services to keep the individual on track in school or work and developmentally. All but one state in the country now have early-psychosis programs, Duckworth says.
Progressive New Programs for Early Psychosis Treatment Take Hold
“There are now 280 early-psychosis programs across America, which is amazing,” he says. The sites are listed by NAMI. “This is a big sea change in the field. A decade ago there were only a handful of these programs. These programs are compassionate. They involve family. They use all the best science about what helps people in these process.” Early-psychosis programs are based on a model of coordinated specialty care, he says. Over time, researchers will assess the programs to understand their long-term impact on patients.
Optimism Surrounds New Approach to Schizophrenia in Youth; More Research Is Needed
“We don’t have any longitudinal studies yet,” Duckworth says. “These clinics haven’t been going on long enough. Most mental health conditions, the earlier you get at them the better the outcome is. That has been shown over and over.” Says Gogtay: “The duration of untreated psychosis — if the psychosis goes untreated for a longer time — that is detrimental to mental health outcomes. [Earlier diagnosis and treatment] may not be able to cure the illness, but what the studies indicate is we might be able to influence the outcome in a more favorable direction.”
