Most mental health conditions are treated after they appear. Given how incomplete our understanding of the brain is, we can only hope that one day we’ll be able to prevent psychiatric disorders instead of waiting for them to do their damage.
But there are some indications that mental health treatment oriented around proactive rather than reactive measures is possible, at least in certain cases. One example is research into the schizophrenia prodrome.
The schizophrenia prodrome is a set of symptoms and behaviors people tend to experience before full-blown schizophrenia emerges. These early signs of schizophrenia can show up weeks, months or even years before the full scale of the disorder becomes apparent.
The bulk of the research on the topic seems to agree that there is a reliable pattern in symptoms that people experience prior to the onset of schizophrenia. In the earliest stages, these people tend to experience general symptoms that, by themselves, don’t point to schizophrenia: depression, social isolation, anxiety, and impaired functioning at work or in school. In fact, one study done over the course of several decades concluded that the earliest stages of schizophrenia resemble depression very closely.
People with schizophrenia often have other, accompanying mental health conditions (known as “comorbid conditions”), and the same is true for people experiencing the schizophrenia prodrome. Somewhat paradoxically, then, one of the first signs of schizophrenia can be a disorder other than schizophrenia.
Over time, these early, general symptoms lead to symptoms that are more specific to schizophrenia but are less intense than the symptoms of full-blown schizophrenia. For example, a 2001 study found that people with prodromal schizophrenia commonly experience the feeling that their thoughts are being modified from the outside.
This symptom of “thought interference” or “thought insertion” is a classic sign of schizophrenia, but people with prodromal schizophrenia experience it less often, less intensely, and with fewer effects on everyday life, than people with outright schizophrenia.
Eventually, prodromal schizophrenia progresses to full-blown schizophrenia. The question, then, is whether this course can be altered if the signs are caught early. This is a topic that researchers are still working on, but so far the evidence seems to suggest that low doses of medication used in conjunction with psychotherapy might delay the onset of the disorder.
Among people who appear to have prodromal symptoms of schizophrenia, it’s not always clear who will go on to have schizophrenia and who won’t. And the earliest signs of the disorder are things like anxiety and depression – most people who experience these aren’t at risk for schizophrenia at all.
Still, for people who have a family history of schizophrenia or similar conditions, symptoms that fit with prodromal schizophrenia are a sign that they might be at especially high risk of developing schizophrenia. If that’s the case, treatment may delay the onset of the disorder, and at the very least will set the groundwork to make things smoother when the disorder does show up. More generally, the fact that people with schizophrenia tend to experience certain symptoms even years before the disorder appears is an indication that in the future, early detection and perhaps even prevention of psychiatric disorders is an intriguing possibility.