Test More Accurately Predicts Teen Psychosis

In the largest study of its kind, researchers found that certain combinations of risk factors may be able to predict whether youth suffering from mental health problems are going to develop full schizophrenia.

In adolescents, the first signs of schizophrenia can include an unexplained change of friends or drop in grades, as well as sleep problems and irritability. But because these types of behavior are evident in many healthy teens, it is difficult to make an accurate diagnosis.

Using current risk assessment standards, youth who are going to develop psychosis can only be identified before their illness becomes full-blown 35 percent of the time. By looking at combinations of those risk factors, the prediction accuracy rises as high as 80 percent.

"When teens have a dive in grades or drop out of the school band, and it happens against a backdrop of family history of schizophrenia and recent troubling changes in perception - like hearing nondistinct buzzing or crackling sounds, or seeing fleeting images that disappear with a second glance - more often than not it indicates that psychosis is fairly imminent," said lead researcher Tyrone D. Cannon, Ph.D., of UCLA.

The seven combinations of risk factors that most often predicted imminent psychosis are listed below:

1. Genetic risk with functional decline + Unusual thought content + Suspicion/Paranoia
2. Genetic risk with functional decline + Unusual thought content + Deteriorating social functioning
3. Genetic risk with functional decline + Unusual thought content
4. Genetic risk with functional decline + Deteriorating social functioning + Suspicion/Paranoia
5. Unusual thought content + Suspicion/Paranoia + Any substance abuse
6. Genetic risk with functional decline + Suspicion/Paranoia
7. Unusual thought content + Deteriorating social functioning + Any substance abuse

Genetic risk means having an immediate family member who also has a history of psychosis. That factor alone can predict whether a youth will also develop the disease only about 35 percent of the time. But when a teen at genetic risk has unusual thoughts and also begins demonstrating another symptom, such as unfounded suspicions or paranoia, or deteriorating social functioning, that is an indicator they may be developing full-blown schizophrenia as much as 60 percent to 80 percent of the time.

Deteriorating social functioning may be defined as spending increasing amounts of time alone in one's room, doing nothing; a new inability to get along with peers and others; or dropping out of extracurricular activities without explanation.

Unusual thoughts can be odd beliefs that are worrisome or which become meaningful because they will not go away. The person may believe there is an external reason for their unusual thoughts which others can prove is not the case.

The research shows that unusual thoughts, combined with substance abuse of any kind, is a highly accurate disease predictor when the adolescent also exhibits suspicion/paranoia or deteriorating social functioning.

"Having this more accurate ability to measure who's likely to develop psychosis will be a great asset. Identifying young people in need of intervention is crucial, but the results of this research can help us do more than that. It can eventually help us determine the most effective time to intervene," said Thomas R. Insel, M.D., director of the National Institute for Mental Health (NIMH).

The psychotic symptoms of schizophrenia (such as hallucinations and delusions) usually become evident in men in their late teens and early 20s and in women in their mid-20s to early 30s. They seldom occur after age 45 and only rarely before puberty. Schizophrenia affects men and women equally and occurs at similar rates in all ethnic groups around the world.

Plans for studies to confirm the results, a necessary step before the findings can be considered for use with patients in health care settings, are underway. For more information about schizophrenia, visit the NIMH Web site at www.nimh.nih.gov/health/topics/schizophrenia/index.shtml.

The research was conducted in youth with a median age of 16 and was funded primarily by the NIMH, part of the National Institutes of Health. Results were published in the January 7, 2008, issue of the Archives of General Psychiatry by lead researchers Tyrone D. Cannon, Ph.D., of the University of California, Los Angeles, and Robert Heinssen, Ph.D., of NIMH, along with colleagues from seven other research facilities. Information in this article came from the research report and from materials published on the NIMH Web site.