Director’s Blog: Can We Prevent Psychosis?

By Thomas Insel on November 20, 2014

Each year, about 500,000 young people in this country seek help for symptoms that resemble the prodrome of a psychotic illness. They are not actively psychotic, but they may be struggling in school, dealing with odd thoughts, and becoming socially isolated. Some describe brief hallucinations or paranoid ideas. Many have become “basement kids,” playing video games alone most of the week and losing interest in the world above ground. Most of these youth will, ultimately, be fine. But about one in three of those identified as high risk will have a first psychotic episode within three years.1

Can we predict which teens will develop a psychotic illness? For heart attacks, we know that obesity, hypertension, and high blood lipids all increase risk. Predicting which adolescent with prodromal features will develop psychosis is not so easy. We lack biomarkers, like blood lipids, that increase risk. Indeed, in most studies, the majority of “high-risk” individuals never go on to develop a psychotic disorder.

Very recently, the North American Prodrome Longitudinal Study (NAPLS) has improved prediction. Combining different types of information—cognitive testing, clinical features (e.g., unusual thoughts, suspiciousness, decline in social functioning), a history of traumatic events, and a family history of psychosis—over 70 percent of those identified as high risk went on to develop psychosis.

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That’s pretty cool for the future. If there was more awareness of mental illness and everyone watched for it we might start winning the fight. It’s too late for me once you have that first psychotic break things get changed in your mind. It sucks but you just have to live with it. I also think that as genetic medicine and knowledge of gene expression is cross referenced and more widespread, like when your genome becomes part of you health profile, it’ll be a lot clearer as to who is susceptible to sz. I’ve never had any genetic work done but it would be interesting to see what genes that I possess play a role. That’s a future technology that will be more widespread in the next couple of decades.

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