By the time most psychiatrists encounter schizophrenia, its
symptoms are already in full flower. But scientists have long
surmised that the illness starts much earlier, the demons beginning
to nibble at the edges of young people's lives well before the most
flagrant psychosis appears.
Now researchers are beginning, in a systematic way, to
investigate the earliest stages of schizophrenia, attempting to
find signs that could predict its onset.
Two research groups are adopting a much bolder strategy: They
are identifying young people at risk and treating them with low
doses of anti-psychotic drugs, even though they do not exhibit the
full-blown symptoms of the illness.
By comparing those who take the drugs with other high-risk
subjects who do not, the researchers, at the Yale School of
Medicine and the University of Melbourne in Australia, hope to find
out if such early intervention can keep the illness at bay, and to
learn more about the factors that predict vulnerability.
The researchers are using the newest anti-psychotic drugs,
medications much less likely to produce serious side effects than
their predecessors. Still, the studies are controversial and have
found no shortage of critics.
Dr. Thomas H. McGlashan, the director of the Yale study, said he
decided to begin his prevention trial when he became convinced,
after many years of working with patients suffering from
schizophrenia, that ``80 percent if not more of the damage is done
before the disorder appears.''
McGlashan cited the findings of as many as a dozen studies
suggesting that the earlier schizophrenia was treated, the better a
patient's prospects were for recovery. After visiting the site of
the Australian trial, he said, ``I began to think that there might
be a way of preventing chronicity with the treatments we already
have.''
Treating people with drugs for a condition they do not yet have
is a highly unusual approach in psychiatry, though it has precedent
in other areas of medicine -- the trial of tamoxifen as a
prophylactic treatment for women at high risk for breast cancer is
one example -- and is being explored for Alzheimer's and some other
diseases.
Schizophrenia and other severe mental disorders are so
devastating that few people would object to the eventual goal of
preventive treatment.
Not everyone agrees, however, that the time is right to attempt
something so ambitious, in large part because, despite researchers'
continuing efforts, there is still no set of indicators that can
predict future illness with any reliability.
