Prospective Observations of Emerging Psychosis

Abstract

Because delays in treatment of psychosis may be associated with poorer outcomes, intervention focus has shifted to the prodromal phase of illness. However, knowledge about this phase has been limited to retrospective reconstructions of symptoms once psychosis is already present. The following article offers a new, prospective view of the development of schizophrenia starting from the late prodromal phase of illness. As we use the term, late prodromal phase of illness means at imminent risk of conversion to schizophrenia. In this article, entry, conversion, and discharge data are presented on a sub-population of eight patients who received treatment for psychosis at onset while participating in a prospective double-blind placebo-controlled treatment study of the prodrome to psychosis. Through disguised case examples, this article then focuses on the course of illness progression in three of eight cases who converted to schizophreniform psychosis while randomized on either active medication or placebo. Discussion focuses on the dimensional quality of the transition both from the prodrome to psychosis and from psychosis to recovery.

Self-reported sleep disturbances associated with procedural learning impairment in adolescents at ultra-high risk for psychosis

“…UHR syndromes were diagnosed using the Structured Interview for Prodromal Symptoms (SIPS; McGlashan et al, 2001; Miller et al, 2003; Rosen et al, 2002). The Structured Clinical Interview for DSM-IV (SCID; First et al, 1995) ruled out psychotic disorders.…”

Experience effects on brain development: possible contributions to psychopathology

“…This period of emerging symptom presentation commonly develops into a pre-psychosis prodromal state on the continuum from normal cognition toward schizophrenia (see Moller, 2001). During childhood and this prodrome, neuropsychological impairments may be phenotypic markers of increasingly compromised brain organization, eventually leading to psychosis (Rosen, Woods, Miller, & McGlashan, 2002). Morphological studies of schizophrenic patients early in their disorders also lend support for developmental theories of schizophrenia.…”

More harm than good: The case against using antipsychotic drugs to prevent severe mental illness

“…However, a series of groundbreaking studies carried out by researchers at the University of Melbourne demonstrated that it may be possible to identify a group of young people at ultra high-risk of becoming psychotic in the immediate future (Yung et al, 1998). Trials of preventative therapy for this ultra high-risk group are already under way in Australia (McGorry et al, 2001) the United States (Rosen et al, 2002), and in Britain (where the authors are close to completing a small clinical trial; (Morrison et al, in press).…”

“…Most of the ongoing studies have employed an atypical neuroleptic for this purpose, either in combination with psychological therapy (for example, in the first study completed in Melbourne (McGorry et al, 2001), or alone (for example, in the ongoing PRIME trial in North America, Rosen et al,2002) or have sought to compare the efficacy of an atypical neuroleptic with the efficacy of psychologica l treatment (as in a trial currently planned at the Institute of Psychiatry). If the results of these studies are successful in crude terms -if the participants who are treated experience fewer psychotic episodes at follow-up than those who do not -the pressure to use this kind of treatment in clinical services may prove almost irresistible.…”