Bir Psikiyatristin Günlüğü

A number of sessions at the annual meeting featured presentations pertaining to the early detection and intervention paradigm for psychotic disorders and research findings were discussed from around the world that may inform future prevention approaches. While the primary prevention of schizophrenia on a population level may remain a somewhat distant goal, early detection and intervention strategies are promising in terms of the secondary prevention of schizophrenia and related psychotic disorders.

In an industry-sponsored symposium entitled “Treating Patients Early: Updates on the Controversy,” ^[1] Patrick D. McGorry, MD, PhD, Professor of Youth Mental Health at the University of Melbourne and Director of ORYGEN Youth Health and the ORYGEN Research Centre in Victoria, Australia, spoke on “The ‘Prodromal’ or Ultra-high Risk Stage of Schizophrenia and Related Psychoses: A Window for Understanding and Intervention.” Dr. McGorry noted that interest in this area was stimulated in part by the 1994 Institute of Medicine (IOM) report entitled “Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research.”^[2] Dr. McGorry stated that the “entrenched level of disability” often associated with schizophrenia (eg, social withdrawal, dropping out of school, substance use, and other social collateral damage) often occurs prior to the initial psychotic episode, during the prodromal period. However, a significant portion of patients who have the same clinical phenotype as the prodrome do not go on to develop a psychotic illness. Symptoms may resolve or patients may develop another illness, such as major depression. Thus, for researchers attempting to identify potentially prodromal adolescents and young adults for prospective research, these individuals would be considered false positives.^[1] Dr. McGorry also described a “false false positive” concept in which patients receive treatment or other protective factors during the prodrome that avert a psychotic episode, thus creating the appearance that the patient had been false positive for the prodrome, but actually the illness had been delayed or prevented.^[1] Also of relevance, Dr. McGorry noted, is the recent work suggesting that the phenotype of psychotic symptoms extends to subclinical features in the general population. For example, the work of Dr. Jim van Os in the Netherlands has shown that up to nearly 20% of individuals in the general population endorse some level of minor psychotic experiences.^[3-5] okumaya devam edin…