Schizophrenia is a mental disorder affecting about 1 percent of the population. It typically emerges in young adulthood—late-teens to mid-20s. Schizophrenia begins with what is called a ‘prodromal phase’ wherein symptoms are just appearing and have not become fully actualized. This prodromal phase can last for a period of weeks, months, or even years. Individuals in this early development of schizophrenia may perceive things that aren’t there, misinterpret social interactions, or struggle with abstract thought—feelings that many people experience at one time or another but that don’t always escalate.
There is no clear-cut explanation for what causes schizophrenia. Genetics is a factor—10 percent of those with a first-degree relative who has schizophrenia go on to develop the condition themselves. But a genetic predisposition is not a guarantee that schizophrenia will develop. Rather researchers increasingly believe that schizophrenia is provoked by a complex interplay of biological, social, and psychological factors; it appears that a variety of environmental stressors mingle with underlying vulnerabilities to incite symptoms. The transition into adulthood can be stressful in itself, and it is often accompanied by exposure to drugs, all of which can contribute to the triggering factors of psychosis.
Antipsychotics have been the long-time primary treatment method for psychotic disorders. Although effective, antipsychotics come along with a host of side effects, and some argue they are mere bandages to underlying problems. However, during the past three decades an alternative method for dealing with psychosis has been making its way around the world.
Patrick McGorry, psychiatrist from University of Melbourne, recognized that young patients experiencing their first psychotic break were quite different from the typical middle-aged patients with full-blown schizophrenia (even though they were treated the same way). McGorry’s work began in the 1980’s and he began taking aim at first-episode psychosis. He and his colleague offered a range of treatment to young adults experiencing prodromal and first-episode psychotic symptoms, including cognitive behavioral therapy, vocational help, family support, and substance-abuse intervention, as well as traditional antipsychotic drugs (although at lower doses).
McGorry found that young patients who receive such multifaceted care early on are more likely to regain their lives, go back to school or work, and are less likely to develop chronic, debilitating schizophrenia. In one study, the risk of developing a full-blown psychotic disorder was lowered by over half.
Theorists argue that a delay in treatment is biologically toxic. Research has illustrated how active psychosis can change the brain in adverse ways over time and lead to less treatment responsiveness. A delay in treatment also generates the more obvious psychological and social toxicity. A young adult who is becoming psychotic misses out on many developmental milestones that peers are going through.
In order to prevent this tragic functional and psychosocial damage, McGorry argues that it is important to do the right things at the right time. Early intervention services for first-episode psychosis have become the norm in parts of Canada and Europe. In 2009, U.S. Congress apportioned $35 million for the development of evidence-based treatment for first-time psychosis. In 2014, it followed up with another $25 million in grants for early intervention programs. Based on data from 34 clinics in 21 U.S. states, the study found that first-episode psychosis patients who receive team treatment, including talk therapy and low-doses of antipsychotics, fare far better than those who receive conventional care.
The main moral to this story is that it’s imperative to intervene as soon as possible after psychotic symptoms begin. Through adequate assessment and care, individuals previously on their way to developing devastating schizophrenia can reclaim their lives.