Over the past week, I’ve come across two very different approaches to schizophrenia prevention. I know to some that may sound like an incredulous possibility. But I believe it’s something that’s achievable within our lifetime.
Schizophrenia is uniquely situated to be acted upon by prevention methods. We know it has a larger genetic component than virtually any other mental disorder today. And unlike many other mental health concerns, it has a list of symptoms to watch out for (prodromal symptoms, they’re called) before it turns into full-blown schizophrenia.
Here’s how we may be able to prevent schizophrenia in the future.
There are two possible ways that we may be able to prevent schizophrenia before it starts: intensive interventions targeted at teens who display the commonplace pre-symptoms of schizophrenia and selective breeding through genetic analysis.
Prevention Through Intensive Intervention Programs
NPR’s “Shots” blog has the story by Amy Standen about a newer way of looking at strategies to help treat schizophrenia before it turns into a full-blown condition. One such program is called Venture Early Intervention Prevention Services (VIPS):
VIPS is one of a handful of programs that have sprung up in California in recent years, based on a model developed in Maine by psychiatrist Dr. Bill McFarlane.
McFarlane believes that psychosis can be prevented with a range of surprisingly low-tech interventions, almost all of which are designed to reduce stress in the family of the young person who is starting to show symptoms.
Those interventions include examining and helping fix negative family dynamics that may exacerbate schizophrenia symptoms in the identified patient. The focus of the program is problem-solving, and reducing stress in the family household. Why target stress? Because stress has been implicated in trigger potential schizophrenic symptoms.
Drugs are also sometimes prescribed. “In some cases, participants are also prescribed antipsychotic drugs, especially one called Abilify, which McFarlane and others believe can stem hallucinations. […] The drugs, he says, should be used cautiously, at lower doses than would be prescribed for full psychosis, and even then only in young people who aren’t responding to other treatments.”
But it’s not the drugs that seem to help the most, according to the article. “When you talk to people who have been through these programs and ask them what helped them, it is not the drugs, not the diagnosis. It’s the lasting, one-on-one relationships with adults who listen, like Ashley Wood.”
I believe such programs are an important addition to our treatment strategies for this terrible form of mental illness. And it’s not just me that believes that — the early research bears out the effectiveness of such programs (see, for example, McFarlane et al., 2014).
Prevention Through Genetic Selective Breeding
The 60 Minutes story from last night covers a different method for the possibility of preventing schizophrenia in the future: simply breeding out the genes implicated in the disease.
This is done through the process of artificial insemination. After an egg is fertilized in the laboratory, scientists remove a cell from the embryo and examine it for the specific genes that are implicated in a specific disease.
Right now the technology can only test for diseases and conditions that are caused by a single flawed gene. But that will likely change in the future as the technology progresses:
That’s in part because researchers still only fully understand traits and diseases caused by a single flawed gene. There’s a lot left to learn about the interaction of multiple genes. But when that happens, Mark Hughes and Lee Silver believe their technologies will be able to screen for a host of genetically complex diseases that they say could include schizophrenia, and some types of diabetes and heart disease.
Imagine that a couple that may have mental illness or schizophrenia present in their family history could go to a lab and be tested for it before ever having a child. The couple then uses one of the embryos that aren’t carrying the problematic genes to have their baby.
Since so many genes are associated with the potential for later developing schizophrenia, it may be awhile before this process can work for mental illness. But today, the technology works for a wide range of conditions, from MS and hemophilia, to Huntington’s disease and certain types of breast and colon cancers.
There are obvious ethical concerns with this process too, and it may be that the government or a professional body limits the use of this technique in the future. But it offers another tantalizing way we may be able to stop schizophrenia, long before it starts.
Read the full NPR article: Halting Schizophrenia Before It Starts
Read the 60 Minutes article (or watch the video segment): Breeding Out Disease
McFarlane, WR et al. (2014). Clinical and Functional Outcomes After 2 Years in the Early Detection and Intervention for the Prevention of Psychosis Multisite Effectiveness Trial. Schizophrenia Bulletin. doi:10.1093/schbul/sbu108