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The outer limits of schizophrenia treatment
Researchers are treating teenagers for schizophrenia before they are diagnosed. Some bioethicists think that's insane.

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By Dawn MacKeen

Dec. 1, 1999 | The photo was a standard elementary school head shot of a beautiful little boy with big, bright eyes and a smile on his face. Eric would keep it in his pocket, and although it was a picture of him years earlier, at age 12, it was a constant reminder of the way things were before. Routinely, he would take it out of his pocket and pass it around for his family to see. He knew something had changed but didn't understand it.

And neither did they. When Eric (not his real name) was diagnosed at the age of 18 with schizophrenia, he and his family watched as his whole world came crashing down. His friends shunned him. His mind played tricks on him, making him believe that angels were speaking to him. And as a result of the antipsychotic drugs, his tall, thin frame became heavy with an extra 50 pounds, sending him over 200 pounds. His hair and beard grew long, giving him a disheveled, wild look. He had become physically intimidating; kids, who once adored him, became afraid.



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Even though his family sensed his anguish and pain, nothing could have prepared them for the news. On a February afternoon, a passerby found his body outside a parking structure in Hollywood. He had fallen four stories to his death. He was only 24 years old.

When Eric was growing up, there was no reason to suspect that he would later become mentally ill. Schizophrenia, which affects 2.3 million Americans, or 1 percent of the population, is the most debilitating of the mental illnesses. It can be chronic and all-encompassing; personalities become tainted by hallucinations, delusions, strange behavior, social withdrawal and confusion; one in 10 ends up committing suicide. Its chokehold varies from person to person -- from the shy, quietly paranoid types to someone like Andrew Goldstein, who is accused of inexplicably pushing a young woman named Kendra Webdale into the path of an oncoming subway train in New York last January.

Patients' rights advocates, psychiatrists, psychologists and family members are trying to find a way to intervene before tragedy can strike. New medications for treating schizophrenics are a vast improvement over the drugs in the past, but they still don't come close to curing it, or dramatically altering its course. Although many schizophrenics are living happy and productive lives, many others spend their years homeless, in jail or in and out of psychiatric wards. And even if a patient ends up getting treatment -- which has always been after the person becomes sick -- the prognosis usually isn't good. Only one in five recovers.

But researchers testing the implications of a new theory are hoping to change that, by preempting the illness and treating people for schizophrenia before they have had their first psychotic episode, let alone diagnosis. They posit that the short period of time before a person begins to exhibit psychotic symptoms may be the key to preventing mental illness. Although it's not conclusive, there is some evidence that the earlier a person is treated, the better the outcome can be. These psychiatrists believe that if they can find a way to intervene before the first psychotic break, then possibly schizophrenia can be prevented, or at least tempered.

"It's important to treat them in the pre-psychotic stage because that's when a lot of the ill occurs," says Dr. Patrick McGorry. He's a professor of psychiatry at the University of Melbourne. "By the time they present their first psychotic symptom -- delusions and hallucinations -- it's already quite late in [terms of] the effects on their lives."

McGorry, along with several other pioneers, including Dr. Thomas McGlashan at Yale, are trying to see if medication might be the answer. They are studying the effects of administering medication to individuals before the diagnosis stage. They are eyeing the "prodromal" stage, the early phase of schizophrenia, to find out if drugs can reduce the symptoms that seem to precede psychosis.

While the practice holds promise for the millions of people who will become schizophrenic, it has become the center of a controversy among researchers studying it. Some ask this simple question: If you're treating people before they become ill, how do you know you're actually treating the right people? Two weeks ago a conference was held in Washington to discuss the ethical ramifications of forging ahead into an area where no one yet knows the consequences.

. Next page | Will these teens end up as guinea pigs in research projects?


 
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