A bold effort is under way throughout the world to understand better the
earliest signs of schizophrenia, use that information to treat young people
developing the disorder, and see whether treating youth showing early signs of
the illness might even halt or prevent it (see story above).
Although this effort is laudatory in principle and is leading to some
positive clinical benefits, it raises some ethical questions for which, at
least at this time, there are no clear answers.
For example, scientists can predict much better today than they could a few
years ago which young people showing warning signs of schizophrenia will
actually develop it, Delores Malaspina, M.D., a professor of clinical
psychiatry at Columbia University, told Psychiatric News. But the
effort is far from perfect. "Over half the young people identified as
prodromal probably will never develop schizophrenia," she said. In fact,
evidence reported in the January British Journal of Psychiatry
supports this conclusion. That study was conducted by Eve Johnstone, M.D., a
professor of psychiatry at the University of Edinburgh in Scotland, and
So, should scientists use antipsychotic medications to treat young people
showing signs of schizophrenia when there is a chance that they will never
develop the illness? Some psychiatrists are for it, some against, Malaspina
What about the issue of stigma for youth who receive early intervention?
Certainly it could stigmatize them, Cheryl Corcoran, M.D., an assistant
professor of clinical psychiatry at Columbia University and co-workers noted
in an article in press with Schizophrenia Research. "The idea
of being at risk for psychosis might affect an individual's choices in terms
of education, employment, or other life plans. It might impact the extent to
which such plans and aspirations would be supported by other family
And should clinical psychiatrists be offering treatment to youth who show
possible early indications of schizophrenia? Malaspina has her doubts.
Nonetheless, she said, a number of psychiatrists are doing so. "What I
think has happened," she said, "is that the clinical community,
seeing that the research community wants to prevent the illness, has jumped
right in. This intervention is very well intentioned. [But] the clinical world
has gotten ahead of the research knowledge."