Preventing Schizophrenia, Part 1 – Overview

Is it too soon to talk about preventing schizophrenia? Is medicine, social policy, or insurance ready to tackle it? What about individuals and families? According to The Schizophrenia Bulletin, “The stage is now set for the ‘implausible’ — the primary prevention of schizophrenia.” The journal recently published a volume addressing this question, and Medscape turned the lead article into a continuing education piece.

These posts distil key information from the journal issue, and input from some additional articles that I pulled in so I could add comments for personal action (not just professional or organizational).

Setting the Stage: Some Background

No single intervention will eliminate schizophrenia because there are numerous causes and vulnerabilities. There are many ways to develop schizophrenia. There are physical vulnerabilities such as genetic risks, and environmental factors that trigger those vulnerabilities, such as certain nutritional deficiencies.

The case for pursuing prevention strategies includes two favored outcomes: 1) The results will probably produce benefits for a wide variety of disorders, and 2) Some strategies are especially favored from a public health perspective because, they are expected to produce a lot of bang for the buck. These tend to be those that produce “nonspecific benefits,” that is, improved health in many people and prevention of a variety of problems that are costly to society.

Strategies for prevention may target high-risk groups, low-risk (but larger) groups, or people with “risk syndrome” (a candidate for being an official psychiatric diagnosis, this diagnosis means that there are early signs that constitute current clinical need; these individuals are at risk for schizophrenia or other kinds of psychotic disorders such as depression that generates psychosis). There are many issues in deciding how to dedicate resources to these groups, such as the risk of false positives, stigma, or low bang-for-the-buck programs. Some argue that the focus should be on “universal prevention” targeting the population in general, because of the difficulty in accurately identifying at-risk individuals, and the desirability of improving well-being and knowledge in the population at large.

High-risk people may be a small group that is difficult to identify and target, while medium-risk people may be so well distributed through the population, that a lower cost-benefit “universal prevention” effort may have more impact with less resources.

The prevention paradox means many people making a sacrifice so that those at risk or who unpredictably come into contact with an environmental risk factor can be helped. But the burden to society is reduced, thereby making the intervention an investment that pays back not only in terms of less suffering, but also in dollars.

In part II, I’ll share prevention strategies (both personal and social) that are promising and some that are not. In part III, I’ll cover approaches that are firmly planted in reality.

References

McGrath, J., Brown, A., & St Clair, D. (2010). Prevention and Schizophrenia–The Role of Dietary Factors Schizophrenia Bulletin, 37 (2), 272-283 DOI: 10.1093/schbul/sbq121