“Preventing the Onset of Psychosis: Not Quite There Yet”


Robert Heinssen and Thomas Insel of the National Institute of Mental Health argue in Schizophrenia Bulletin that the balance of evidence does not support early intervention in psychosis.

“Promising results have been reported for cognitive-behavioral therapy, alone or in combination with family therapy, and omega-3 fatty acids,” they write. “Available data do not support antipsychotic medications as a first-line treatment for [clinical high risk] patients.” Most of the studies have been marred by poor trial designs, they argue.

Insel elaborates on his thoughts in his own blog.

Preventing the Onset of Psychosis: Not Quite There Yet (Heinssen, Robert K. and Insel, Thomas R. Schizophrenia Bulletin. First published online: November 11, 2014. doi: 10.1093/schbul/sbu161)

Can We Prevent Psychosis? (Directors Blog, National Institute of Mental Health, November 20, 2014)


  1. Nice that they acknowledge reality but if it’s going to stop anti-psychotics being prescribed to “prevent” schizophrenia, that’s a different issue. Psychiatry’s own guidelines about prescribing are notoriously broken and nobody faces any consequences ever.

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  2. Fascinating that they are talking about associations with childhood trauma and social isolation, and that in the last sentence, he seems to imply that psychotic individuals are “withdrawing from life,” indicating an intentional (if perhaps unconscious) decision-making process involved in the eventual development of “schizophrenia” (whatever that really means). Sounds like the evidence is suggesting a pretty different narrative than that given to those so diagnosed by the system, who are told their brains aren’t working right and that it’s all genetic and their family and other early life experiences have nothing to do with it (“Let’s not blame the parents!”) and that they have no control over what happens next. Doubtful that anyone at NIMH or in the field will notice the contradictions, though…

    —- Steve

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