A global pre-emptive strike at schizophrenia
While we don’t know exactly what causes schizophrenia or have the means to cure it, there is a growing sense of optimism that we may soon be able to prevent it.
It is widely agreed that a young person who is beginning to show symptoms of psychosis is much better off receiving therapy early – and understanding this “high risk” group further will lead to finding ways to pre-empt one of the most severe mental illnesses.
Two major international research collaborations are zeroing in on how to predict who will develop psychosis, and which therapeutic elements are effective in preventing it.
“The goal is to transform the way we care for people at high risk of developing schizophrenia,” says Dr. Romina Mizrahi, who heads the Focus on Youth Psychosis Prevention Clinic and Research Program at CAMH. Dr. Mizrahi is a Clinician-Scientist with the Campbell Family Mental Health Research Institute.
Those who are considered at high risk of schizophrenia are starting to have symptoms, such as hearing voices or having feelings of suspiciousness, but are aware these experiences are not real and find them upsetting. We now know that about a third of this high-risk group will go on to develop schizophrenia, while a third will completely recover.
Speeding the pace of discovery with a larger pool
Multi-site research collaborations are important because they combine the relatively small numbers of those at high risk in any one centre, giving more statistical power to findings that can show which individuals are likely to develop schizophrenia, why, and which therapies may be effective in preventing illness.
Dr. Mizrahi and the Focus on Youth Psychosis Prevention (FYPP) Program are contributing patient data to such collaborations, including Psyscan, a project of the European Commission on Research and Innovation, and the U.S.-based North American Prodrome Longitudinal Study (NAPLS) as part of what is called the Harmony project funded by the U.S. National Institutes of Mental Health (NIMH). Both studies are collecting detailed biological information on patients – using measures of imaging, genetics and electrical activity of the brain, as well as clinical measures.
The Psyscan study has a specific focus on creating a new predictive tool for use in treatment. Clinicians will supply patient information, which will be processed and analyzed at a central facility, to make predictions specific to the patient. The NAPLS team is tracking 350 people in the high-risk group over time, to identify some of the precise biological factors that might predict who is likely to develop schizophrenia, and who won’t.
Promise of prevention
Prevention can take many forms, but one of them is to target some of the external influences that can contribute to the development of schizophrenia. Stress is one factor that can trigger psychosis in those who are vulnerable, says Dr. Mizrahi, “so a new way to treat people may be to enhance their resilience, and tap into their strengths to develop strategies to deal with stress.” The FYPP Clinic’s 12-week program has a focus on helping individuals with techniques to manage stress and potential triggering situations to help them minimize the impact on their mental health, with the ultimate goal of preventing a major mental illness.
Other preventive approaches are also under investigation at CAMH and elsewhere. Omega-3 fatty acids have been shown to lead to beneficial outcomes in two studies, says Dr. Mizrahi. Mindfulness, which is used in managing mood disorders, also shows promise.
There is also evidence that a type of antidepressant, selective serotonin reuptake inhibitors, reduces the risk of psychosis in some individuals. If medication is needed at this high-risk stage, the goal is to minimize the use of stronger antipsychotics, she says.
Collectively, at least 25 sites worldwide are participating in this research through these initiatives. Psyscan, for example, has sites in Taiwan, Brazil and Canada, in addition to several locations across Europe.
“Working together is the only way we can make fast progress in understanding the development of schizophrenia, and prevent it from occurring in this high-risk group,” says Dr. Mizrahi.
This research is an example of how CAMH is contributing to a healthier, wealthier, smarter Ontario.