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On May 7 th the Emory University Graduate Students in Psychology and Neuroscience (GSPN) hosted a colloquium talk given by Vijay Mittal , assistant Professor of Psychology and Neuroscience at the University of Colorado at Boulder. In the talk, titled “Translational Clinical Science in the Psychosis Prodrome: From Biomarkers to Early Identification and Intervention,” Dr. Mittal, who received his Ph.D. from Emory, discussed some of his research on the prodrome for schizophrenia. 1 Dr. Vijay Mittal The prodrome for schizophrenia is a collection of neurological and psychological symptoms that can indicate risk for developing schizophrenia (as has been discussed previously on this blog) prior to the development of clinically relevant symptoms. Research on the prodrome is gaining much attention and funding because it could lead to a better understanding of how schizophrenia develops and better ways to intervene prior to its onset. Mittal began his talk with a background on the schizoph...

Prophylactic medicine is the new medicine. The primary ethical issue brought up by the paper revolves around the notion of diagnostic testing. Everyone wants to try and catch the disease early so that we can come up with treatment options and help them salvage whatever quality of life they have left. The problem arises because these tests are not perfect. They sometimes miss the targets, leading to false negatives. They also sometimes hit targets that aren’t actually targets, leading to false positives. In both cases, there could be catastrophic consequences. It’s usually one or the other though. So when the condition is more dangerous than the treatment, it’s important to minimize the false negatives, such as in the case of cancers. When the treatment is more dangerous than the condition, however, it’s important to minimize the false positives, such as for hypercoagulability. In the case of schizophrenia, it appears that the symptoms of the condition outweigh the commitment and side-e...

David Dobbs describes new developments in schizophrenia research, prodromal schizophrenia, and potential new treatments for the disorder in “The Making of a Troubled Mind”. He cites several recent advancements in researchers’ understanding of the disease and indicates that targeting GABA receptors is a promising pharmacological therapy. Like many psychiatric and medical diseases, schizophrenia presents itself in various subtle ways before it may be clinically recognized and diagnosable. This is because the mechanisms behind the disease—dysfunctional pyramidal and chandelier cell structure and activity, at least in part—are present throughout a person’s life but only start causing significant, noticeable problems in adolescence. Pre-clinical signs of schizophrenia may include paranoia, cognitive impairments, hallucinations or “peculiar” thoughts. Dobbs mentions a survey to assess a young person’s risk of developing schizophrenia—the Structured Interview for Prodromal Syndrome. It has sh...

If science has one defining tenet, it would be the pursuit of knowledge. By pushing boundaries and expanding the horizon of the possible, science itself seems antithetical to the old adage "Where ignorance is bliss, 'tis folly to be wise." 2 But the philosophy of truth and the reality of its application are two very different things. As clinicians’ ability to diagnose conditions earlier and earlier improves, a complex ethical issue arises. Where exactly does one draw the line between the bliss of ignorance and the benefits of knowledge? Such a debate hinges on two questions: What are the inherent ramifications of that knowledge, and what benefits does it grant. The first question is the more complex, as it begs at the very ontology of disease, when knowledge is but an echo of future sorrow, whose ears wish for such a burden. Yet by knowing the future, you can prepare. Thus knowledge, in itself, of a future disease or disorder is a double edged blade. It cuts through the ...

In the last decade, there has been a push to develop and characterize a diagnosis for adolescents at high-risk for schizophrenia, called prodromal risk syndrome. 1 The Personal Assessment and Crisis Evaluation (PACE) clinic in Melbourne, Australia, was first to develop a classification of prodromal syndromes. 2 The disease of schizophrenia is most typically diagnosed in early adulthood, when most schizophrenics experience their first psychotic break, therefore, early intervention tactics are aimed at adolescents. This is one of the reasons that the PACE clinic is located in a shopping mall. 3 On the other side of the globe, the North American Prodrome Longitudinal Study (NAPLS) has been developing and improving methods to reliably diagnose individuals in the prodrome stage. Once identified, they offer these individuals psychotherapy, family therapy, drugs, or cognitive training to hopefully lessen the progression of symptoms. Their method of assessment scores symptoms including ...

John Forbes Nash Jr. was a brilliant mathematician at Massachusetts Institute of Technology when in 1959 he began to exhibit extreme paranoia and erratic behavior. Later that year, he would check into a mental hospital where he would be diagnosed with schizophrenia. Although over 50 years have passed since that time, schizophrenia has no cure, no well-defined cause, and no means of prevention. Schizophrenia is debilitating and extremely costly, not only to patients and their families, but also to society at large. Approximately 1% of the world's population will be diagnosed with schizophrenia within their lifetime. Recent research has focused on identifying individuals at the highest risk before the full onset of psychosis, but these efforts have proven highly controversial due to ethical concerns. The North American Prodrome Longitudinal Study (NAPLS) has championed efforts to characterize the schizophrenia prodrome, which is defined as early symptoms of the disease that may be...

How has research on schizophrenia recently changed? In the past twenty years, schizophrenia research has turned its attention to the symptomatic period preceding a transition to the first episode of psychosis 1 . In an attempt to prevent or at least dampen the cognitive, social, and psychological deterioration associated with the development of schizophrenia, research has identified a host of symptoms now described as “prodromal symptoms” to schizophrenia 2 . The prodrome is the period of subclinical symptoms that develop prior to the onset of an illness, such as visual aura leading up to the onset of a migraine. With schizophrenia, these symptoms have a diverse range of manifestations from depression to grandiosity (an unrealistic sense of superiority), have no definite linear progression, and can only be retrospectively identified as prodromal schizophrenia once a transition has occurred. Until the patient develops full onset schizophrenia, symptoms can only be accurately described ...