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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