Early detection and intervention in psychotic illnesses such as schizophrenia and bipolar disease in adolescence could perhaps prevent some of the devastating effects of mental illness, according to researchers with the Cognitive Assessment and Risk Evaluation (CARE) program at the University of California, San Diego (UCSD) Medical Center.
Kristin Cadenhead, M.D., associate professor of psychiatry, is director of the CARE program. CARE's primary goal is to identify and assess adolescents and young adults who experience changes in their thoughts, behavior or emotions that might signal the development of serious and disabling problems.
"Adolescence is a highly emotional time of life, which makes it particularly difficult for teenagers or their parents to know when to seek help. But, early identification of warning signs and therapeutic intervention may help to delay or prevent the onset and decrease the severity of a serious mental illness," said Cadenhead.
Participants in the program are assessed by UCSD physicians who are experts in the study of serious mental disorders that affect young people. The CARE program, supported by a research grant from the National Institute of Mental Health, offers services free of charge and is completely confidential.
Researchers estimate that 25 to 30 percent of patients exhibiting early warning signs of a serious mental disorder become psychotic within a year. Such signs might include hearing voices, seeing visions, experiencing strange sensations or imagining things; developing a preoccupation with new, unusual beliefs, or ideas about mind control; or behavior that is eccentric or strange. Other non-specific symptoms may also be present, including deterioration in school or work functioning, social withdrawal or isolation, reduced concentration and attention, anxiety, confused thinking and sleep disturbances.
Cadenhead added that it is of primary importance to avoid stigmatizing or labeling an individual, since it's not always clear what such emotional and behavioral changes mean. "Obviously, more than 70 percent of young people who experience changes in behavior, thoughts or emotions are in distress but will not necessarily develop a psychotic disorder," she said. "Our goal is to assess and help treat those at risk of developing a severe mental illness."
Participants in the CARE program must be between 12 and 30 years of age. After enrollment, they are followed for two years with regular clinical and cognitive assessments. Although the CARE program is not a treatment study, it does provide free resources such as psychiatric consultation, social services, and education for both the individual and family members. If participants are not currently in treatment, the UCSD staff and clinicians will ensure that they receive needed care through UCSD or resources in the community.
"Ultimately, we hope these treatments help delay the onset and development of mental illness," said Cadenhead, "but we also hope to decrease its severity."
Young people with a sibling or parent with schizophrenia are at higher risk of developing the disease, and are eligible for the program if they have exhibited recent deterioration in the ability to cope with life events and stressors, which might be expressed as poor concentration, decreased motivation, withdrawal from family and friends, depression or anxiety.