In this guest post, Dr Jackie Curtis, a psychiatrist who actively works with young people with mental health problems at the Prince of Wales Hospital, and Dr Georgie Paulik, a clinical psychologist, explain how the onset of psychosis may be prevented or delayed in high-risk youths and describe some of the research which is currently being undertaken to understand more about the onset of psychosis.

Many changes take place in the developing brain, mind and body of adolescents. This process of change and maturation leaves adolescents particularly vulnerable to developing the unusual and often frightening symptoms associated with psychosis.  Some of the youths who have “odd” experiences, will go on to develop a psychotic illness, such as schizophrenia or bipolar disorder, while others will not. It is not yet entirely clear who will and who will not go on to develop a psychotic illness, although research currently being conducted around the world, including a large-scale project running in NSW, is endeavouring to find out. Despite this paucity in understanding, effective and non-intrusive treatments aimed at preventing, or delaying, the transition to psychosis for youths identified to be “at-risk” are available.

Identifying who is at risk of developing psychosis is a critical step in preventing transition.  Large-scale studies have found that the most highly predictive risk factors for transition are a drop in functioning (i.e. marked social withdrawal, drop in academic functioning, increase in school or work truancy, and/or general low motivation), accompanied by any of the following: (1) a first degree relative (parent or sibling) with a psychotic illness; (2) brief or attenuated/sub-clinical odd or unusual beliefs/thoughts (i.e.  seeing special meaning in things around them, thinking that people are reading their mind or putting thoughts into their head, thinking that people are trying to harm them etc); (3) perceptual disturbances (i.e. things look/sound/smell/taste different, e.g. more or less vivid) or brief hallucinatory-type experiences; and/or (4) marked decrease or impairment in verbal, expressive communication skills. Youths meeting these criteria will often also have other mental health concerns, such as depression and anxiety. If while reading this someone you know comes to mind, they may be at risk of developing psychosis. Fortunately research findings show that there are a number of ways to prevent or delay the transition to psychosis.

It is imperative that first line treatments for individuals identified as being at-risk of psychosis are safe and have minimal side effects, since there is no certainty that without treatment these youths will transition. Thus, although research studies have found some evidence that antipsychotic and antidepressant medications can prevent, or at least delay, the onset of psychosis, the use of these medications should be reserved for youths who fail to respond to more gentle therapies or have more severe psychotic-like symptoms. The two safest, yet effective interventions are omega-3 fatty acids (“fish oil”) and Cognitive Behaviour Therapy (CBT). A recent study found that at one year follow-up, ultra-high risk youths who had been taking 1.2 g/d of fish oil daily were six times less likely to have transitioned to psychosis , had significantly less psychotic symptoms and higher over all functioning, than those youths who were not receiving treatment. Fish oils are safe to take regularly and have no common side effects. CBT – a type of talk therapy – has comparable positive effects in at-risk youths to that of fish oil, with reduced transition rates and fewer symptoms after 6 months of weekly therapy sessions (group or individual). CBT is a first line treatment for mood and anxiety disorders, and thus is often the first choice treatment for youths also suffering from these concerns. Medicare now covers most of the costs of seeing a clinical psychologist for CBT via referral from a GP.

A new youth-based service aimed at identifying and tracking youths who are at-risk of developing psychosis has recently opened its doors at Bondi Junction Community Health Centre (BJCHC). The team provide a comprehensive psychological assessment for appropriate referral s, and then on identifying the specific needs and risks of the client will make referrals to relevant youth services for treatment. For youths suspected of being at-risk, aged 14-24, and living in the Eastern Suburbs, referrals can be made through the Prince of Wales Acute Care Team (tel. 9366 8611). At-risk youths (both in and out of catchment area) can also participate in a large-scale Australian based research project being run at the BJCHC. The project aims to advance our understanding of the causes and risk factors of psychosis to assist early detection and intervention. Participants in the research project can learn about their own cognitive strengths to facilitate their learning, and are also financially reimbursed. For referrals to research or for more information, please contact Dr Georgie Paulik on 0401 661 806.

Writers Dr Jackie Curtis and Dr Georgie Paulik. Editor Dr Ramesh Manocha.