Poor Grades, Irritability, Suspicion. What Distinguishes The
Beginnings of Schizophrenia From Normal Adolescent Turmoil? New
Research Identifies Key Warning Signs, Tralee Pearce Reports

A DISORDER IN DISGUISE

It was a routine question: "Is there anything else you want to
add?"

And in retrospect, Ridwan Tahseen's decision to answer the school
counsellor truthfully was nothing less than life-changing. Otherwise,
he may have been on a fast track to schizophrenia. Mr. Tahseen's
university grades had plummeted so far that the 20-year-old was
talking to his counsellor about being suspended. Feeling he had
nothing to lose, he blurted out a string of disturbing revelations: He
was devastated by a breakup. He had been cutting himself. In crowds,
he thought people were staring at him and about to harm him.

"She was shocked," says Mr. Tahseen, pulling up his right sleeve to
reveal the wide scar he showed her that day. Faded now, it runs along
his inner arm, elbow to wrist.

In a swift chain of events, he was referred to a program at Toronto's
Centre for Addiction and Mental Health specializing in monitoring and
treating young people with early signs of severe mental illness.

Doctors saw in him hints of schizophrenia. "They said, 'You don't have
it. But we have seen symptoms of it,' " Mr. Tahseen, now 22, says in
an interview in a CAMH meeting room. He and his doctors have been
tackling his early symptoms in the hopes of either preventing
schizophrenia from happening or, if it does occur, lessening its
severity. Schizophrenia is perhaps the biggest mystery of modern
psychiatry. A person with schizophrenia has trouble distinguishing
between what is real and what is not.

He may hear voices or experience hallucinations, paranoia, delusions,
serious disability and violent impulses.

Three in every 100 people will experience a psychotic episode in their
lifetime and one in 100 will have schizophrenia. Often emerging during
the teenage years, many of the signs - a sudden drop in grades,
irritability, feeling suspicious and withdrawing from family - happen
to look a lot like adolescence in general.

"It's hard to differentiate the beginnings of illness from normal
adolescent turmoil but there are differences," says Jean Addington, a
psychiatry professor, researcher and the director of the Prevention
through Risk Identification, Management and Education program Mr.
Tahseen visited.

While there have been advances in treating people immediately after
their first psychotic episode, many researchers are looking to detect
the risk factors before they erupt. Even successfully treated
schizophrenia patients say that getting a handle on their condition
earlier could have spared them some of the more serious effects, such
as hospitalization.

The PRIME Clinic has been open for nearly a decade, but the field of
preventative mental-health care is still in its infancy, so patients
often double as research subjects.

Dr. Addington and her colleagues at clinics in Connecticut, North
Carolina and Calgary follow patients for years after they first seek
help.

By looking back at the particular warning signs in those patients who
go on to develop full-blown schizophrenia, the researchers are able to
refine their understanding of which "prodromal," or pre-illness,
symptoms are the most predictive.

Their most recent research, published in January in the Archives of
General Psychiatry, drew on the experiences of 291 patients and
identified five reliable early-warning signs. Until recently, the only
hard evidence of risk was that one in 10 people with a parent or
sibling with schizophrenia would go on to develop it, which, Dr.
Addington says, wasn't much use as a preventative measure.

Some of the risk factors are similar to the full-blown characteristics
of the illness, such as unusual thought content, suspicion/paranoia,
perceptual anomalies, and disorganized communication. Others are not,
such as a feeling of grandiosity. Of people with the five symptoms, 20
to 40 per cent go on to experience psychosis within 30 months.

Only a handful of PRIME patients go on to suffer a first episode each
year, Dr. Addington says, yet about 200 people visit the centre's
first-episode clinic.

"We're just touching the tip of the iceberg. So where are all the
others?" she asks. "It may be some of them don't think they have an
illness. It may be stigma, or fear of what doctors might confirm. Or
they may believe the early symptoms."

Hence the push to increase mental-health literacy among teachers,
counsellors and anyone who deals with youth, says Chris Summerville,
the interim CEO of the Schizophrenia Society of Canada. Up to 70 per
cent of people with schizophrenia recover, he says. "We can enhance
that recovery with early discovery."

And that doesn't mean simply prescribing anti-psychotic medication
early. Treatment for PRIME patients begins with psychological and
social help, and attention for related problems such as depression.

Young patients are strongly advised to steer clear of marijuana, since
recent studies have linked heavy pot use with an earlier and more
intense onset of schizophrenia.

Those studies may also be a clue that schizophrenia as we know it is
on the rise, says neuroscientist James Kennedy, head of the
Psychiatric Neurogenetics Section, at CAMH and a professor of
psychiatry at the University of Toronto.

"Since marijuana is more widely available in North America over the
past 40 years or so, this could be contributing to increased rates of
schizophrenia."

For those not detected early, Dr. Kennedy's genetic research aims to
minimize the negative side effects of anti-psychotic drugs, such as
obesity, diabetes and the involuntary movements known as tardive
dyskinesia. A new lab is about to open at CAMH this month to offer
this gene-based pharmacological advice to psychiatrists before they
prescribe.

There's a good chance that Mr. Tahseen will never receive this
analysis. He has stayed in school, now studying international
development; he plays soccer regularly, and works part-time. His
psychiatrist visits have been scaled back to once monthly and he
continues to use sleeping and anti-anxiety medication only
occasionally.

Every time a Columbine-style shooting is in the news, though, he sees
an alternate path his life could have taken as a result of his budding
paranoia. "You don't think about who is innocent. You're so frustrated
and sad and angry. At that point, that's what I felt."

David can relate. He was a popular 24-year-old student with good
grades when a breakup - in addition to heavy pot use, he believes -
triggered a severe first episode in which he was hospitalized after
threatening roommates.

David, who declined to be identified, was released to his parents'
home outside Toronto and months later sought help at CAMH. Diagnosed
with schizoaffective disorder - schizophrenia with an added mood
disorder element - he began a successful five-year course of
anti-psychotic medication and psychosocial therapy.

Still, he wonders what might have happened if he had been flagged
early. He did visit his university's health centre before his first
episode, describing mood swings and suicidal feelings.

"They prescribed the wrong drugs, without any follow-up, without any
referral to a psychiatrist," he says, adding that negative side
effects of the drugs, including twitches, only added to his
instability. "They had an opportunity early on to get [me] some
intervention, to get some help. I was at risk of something."

Compounding the problem, however, is the fact that paranoia itself can
deter people from seeking help. Marie Asuncion, 23, had her first
episode at 15. Before that she recalls rebuffing a schoolmate who
asked her if something was wrong. "Could I have gotten a little bit of
support?" Ms. Asuncion asks. "But at the same time, if I told everyone
what was wrong I probably would have gotten more sick, because you
worry about what people are thinking about you."

Mr. Tahseen has been coached to tweak this kind of thinking. When he
worries he's being watched, he tells himself, "Maybe they're not
looking at you. Maybe they're looking at the logo on your shirt."

Mr. Tahseen is confident he has dodged schizophrenia, "I feel I'll
never end up there."

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RISK FACTORS

Signs a teen may be at risk of developing psychosis:

trouble concentrating or thinking clearly.

confusion about what is real or imaginary.

hearing voices or seeing things that aren't really
there.

feeling suspicious or paranoid.

disorganized speech, racing or slowed-down thoughts.

irrational ideas of special identity or abilities.

problems with social activities at work or at school.

people who have a family member who has a mental illness, and who are
now experiencing their own difficulty functioning, are also considered
to be at some risk.

Source: CAMH

RESOURCES FOR TREATMENT

Schizophrenia Society of Canada: http://www.schizophrenia.ca

Canadian Mental Health Association: http://www.cmha.ca

Centre for Addiction and Mental Health: http://www.camh.net

Prevention through Risk Identification, Management and Education
Clinic (PRIME): http://www.camh.net/prime_clinic

PRIME clinic, Calgary Health Region: http://www.thesoonerthebetter.ca and
http://www.earlypsychosis.ca