(Oct. 24, 2018) After experiencing the first onset of psychotic symptoms, individuals and their families may feel worried, confused, or alone and wonder, "What's next?"
But what if that question had an answer? What if individuals at risk of developing schizophrenia were able to predict their own unique likelihood of entering psychosis?
Research presented last Friday at a meeting of the Alliance for Research Progress, a panel of advocacy organizations convened by the National Institute of Mental Health (NIMH), recently shed light on the success of a new psychosis risk calculator. The meeting also offered NIMH updates from Director Joshua Gordon regarding organizational shifts within the agency and progress on NIMH research initiatives. Unfortunately, he did not directly address the concerns we reported about the agency's decision to stop funding research into improving drug treatments for schizophrenia.
 |
"Prediction and Prevention of Psychosis in At Risk Youth"
While 20-35% of individuals ages 12-35 exhibiting early signs of schizophrenia experience full psychosis within 2 years, Tyrone D. Cannon, PhD, and fellow researchers found that clinical high-risk patients can have wildly varying individual risk levels. A one-size-fits-all assessment of risk neglects unique factors such as age of symptom onset, family history of psychosis, and the presence of stressful life events-all of which have been shown as predictive of psychosis.
By analyzing data from a multi-year study of clinical high-risk patients, Cannon and authors developed a dynamic risk calculator that generates the risk of entering psychosis using patients scores from various clinical assessments. The calculator generates the likelihood of psychosis at the one- and two-year marks following symptom onset.
While it may be tempting to view the new tool as a crystal ball for individual disease progression, the researchers stressed its limitations. Only specifically-trained clinicians can administer the assessments used to generate risk. Without a patient's official scores on these assessments, the tool cannot accurately serve its intended purpose. Additionally, study subjects were both high-risk and treatment-seeking; characteristics that certainly do not describe every individual experiencing psychotic symptoms.
However, within the given population, the risk calculator was found about as reliable as existing risk calculators for other illnesses and could be instrumental in helping patients and their families make informed treatment decisions.
NIMH Updates
As mental health plays an increasingly large role in the United States' political landscape, NIMH Director Joshua A. Gordon, began with an overview of the agency's recent work in Congress, which included meetings with the neuroscience and mental health caucuses to help prioritize issues such as suicide prevention.
Dr. Gordon also spoke about improvements to online resources from the NIMH. He cited the agency's re-organized website, designed to make finding data on the prevalence, treatment and consequences of mental illness easier and more accessible to the public. However, the website still incorrectly states the prevalence of schizophrenia in the United States as between 0.25% and 0.64%, well below the 1.1% previously used.
Earlier this year, the Treatment Advocacy Center wrote about a change on the agency's website regarding the prevalence of schizophrenia. Read our paper, and Dr. Gordon's response, here.
Dr. Gordon mentioned NIMH science updates as well, which included early findings on ketamine for treatment-resistant depression and the potential role of immune system genes in the development of schizophrenia. Relatedly, Dr. Gordon emphasized the agency's shift away from funding new genetic schizophrenia research, and toward further research of genes already suspected of having an impact on the development and progression of the disease.
Given the Treatment Advocacy Center's long-running concerns that the agency fails to appropriately prioritize severe mental illness, we will remain watchful of how these projects develop and whether they are drawing resources and attention away from more effective research.
Jessie Walthall
Research Assistant
References:
- Cannon, T. (2016, July). "An Individualized Risk Calculator for Research in Prodromal Psychosis." The American Journal of Psychiatry.