Scientists Can Predict Psychotic Illness in Youth
Scientists can predict psychotic illness in up to 80 percent of high-risk youth according to a study by the National Institute of Mental Health.
Akinso: Scientists can predict psychotic illness in up to 80 percent of high-risk youth according to a study by the National Institute of Mental Health. Youth who are going to develop psychosis can be identified before their illness becomes full-blown 35 percent of the time if they meet widely accepted criteria for risk, but that figure rises to 65 to 80 percent if they have certain combinations of risk factors. Dr. Robert Heinssen, the study's principal investigator, breaks down the focus of the study.
Heinssen: This study focuses on our ability to predict individuals who are at highest risk for developing a psychotic disorder within a timeframe that actually can inform clinical decision making. So prior to this study the best predictor of who is going to go on to develop psychosis was family history of psychotic illness. If you had a first degree relative, that being either a parent or a sibling who had a psychotic disorder, your risk was somewhere between 10 and 12 percent over the course of a lifetime. With this study we use a set of clinical indicators that are evaluated in a structured diagnostic interview and we found that individuals who meet these clinical characteristics have a 35 percent risk of developing psychosis over a 30 month interval. So we've been able to triple the predictive accuracy with this new instrument and we've been able to clarify the risk window from a timeframe of decades to a timeframe measured in months.
Akinso: Dr. Heinssen said knowing what the combinations of risk factors are can help scientists predict who is likely to develop the illnesses within two to three years with the same accuracy that other kinds of risk factors can predict major medical diseases.
Heinssen: So the criteria that have been tested are the presence of what's called attenuated positive symptoms. So these would be changes in thinking and communication that would be seen as milder forms of the types of disturbances that we see in active psychosis. So for example unusual thoughts, suspiciousness and paranoia, disorganized communication. Those would all be examples. At a given level of severity, at a given timeframe, we would say that the person has stepped out of the normal range of experience on these dimensions and now is in a precarious risk state that we would want to monitor carefully to see whether that progressed further. Additional ways that you could be in this risk state are if you had a family history of psychosis similar to what I was describing before. But on top of that you've had a significant functional decline over the preceding 12 months. So you've experienced noticeable changes in your ability to take care of yourself or to perform your roles as either a student or a worker that would be another root to this.
Akinso: The other combinations of risk factors that predicted psychosis were past or current drug abuse, and the deteriorating of one's social functioning. According to Dr. Heinssen research shows that intervention during the early stages of psychosis improves outcomes, but it is not yet clear if even earlier intervention, before a psychotic illness develops, is effective. Dr. Heinssen emphasizes that researchers now have the tool that actually has value for clinical practice today.
Heinssen: If a young person presents at a clinic and they are evaluated using the structure diagnostic interview and are found to be in this risk state, what it tells us is that you can treat the symptoms that they present with that have existing therapies associated with them.
Akinso: Dr. Heinssen added that once researchers identify people as being high risk, they have a very good chance of knowing whether or not they're likely to develop a serious mental disorder like schizophrenia and that, if they do, it will happen fairly quickly. This is Wally Akinso at the National Institutes of Health Bethesda Maryland.
About This Audio Report
Reporter: Wally Akinso
Sound Bite: Dr. Robert Heinssen
Topic: Psychotic illness