Doctors are planning to seek approval for trials of anti-psychotic drugs in teenagers to prevent schizophrenia, the severe mental illness that can lead to lifelong hospitalisation and suicide in those at high risk.
Prescribing powerful drugs to children who are not suffering from schizophrenia, and who may never develop it, will raise acute ethical concerns. Trials in the United States, Australia and Switzerland have already been criticised for causing overdiagnosis of the condition. But affected families are so desperate for help they are prepared to make their children take the drugs experimentally.
At stake, say scientists, is the prospect of a major advance against a severe mental illness which affects 200,000 to 300,000 people in Britain, and over 5 million in Europe and America. One in five of those who have a first attack of the illness never have another. Studies show that treating the disease early, within two to six months of the onset of symptoms, can dramatically cut the number of lifelong sufferers. If the disease can be caught before it starts, doctors hope the number of sufferers might be halved.
At the Yale Psychiatric Institute in New Haven, Connecticut, 19 young people are being treated with olanzapine, an anti-psychotic drug, or a placebo, plus conventional talk therapy, on the basis of what are called "prodromal" symptoms which may, or may not, be a warning sign of schizophrenia. The symptoms include peculiar behaviour, odd speech and perceptions, intermittent delusions and paranoia and "magical thinking". Many of the young people also have a family history of schizophrenia, which increases their risk five to 10-fold.
Professor Thomas McGlashan, who is running the trial, told the Wall Street Journal that the risks of the drugs had to be set against the horror of the illness. It was frightening to watch someone develop the disorder. "Someone is losing their mind, their most human part," he said.
Tim Crow, professor of psychiatry at the University of Oxford, said several groups of researchers in Britain are keen to run similar trials. "There are excellent modern anti-psychotics which are relatively free of side-effects. They have enhanced effects when used early with greater rates of remission."
Treating prodromal cases yielded "incredibly good" results and at low doses the new anti-psychotics did "relatively little harm" to those who did not need them, he said. After a year it would be clear which cases were going to develop schizophrenia and the rest could come off the drugs.
In Britain, schizophrenics go two to three years on average before being diagnosed. During that time, substantial damage is done to the brain.
A spokesman for the National Schizophrenia Fellowship said: "We would be in favour of the earliest possible intervention but there would have to be good evidence that the person is developing a severe mental illness. These drugs do have side-effects. They are by no means clean."Reuse content