In Schizophrenia Bulletin, Columbia University psychiatrist Paul Applebaum reviews the challenges of intervening early in psychosis before symptoms emerge, and of doing so in an ethically responsible manner when risks may outweigh possible benefits.
“However great the importance of exploring such possibilities, care will be required to minimize the chances of harming the very people we are seeking to help,” writes Applebaum.
He suggests that telling children they’re “at risk” for schizophrenia may create “anxiety and distress,” and questions the risk/benefit ratio if administering antipsychotic medications “to a group of adolescents, the majority of whom will not progress to schizophrenia.”
“Since only a minority of the probable target populations in primary prevention studies will develop schizophrenia in the absence of intervention, the majority of participants are unlikely to experience benefit from even an effective preventive measure,” notes Applebaum. However, he adds, perhaps some interventions, particularly psychosocial therapies, might have other benefits. “Insofar as treatments have positive secondary consequences apart from reducing psychosis risk — such as improved social adjustment, better parent-child interactions, or enhanced cognitive function — it will be easier to justify their application to these groups.”
Appelbaum, Paul S. “Ethical Challenges in the Primary Prevention of Schizophrenia.” Schizophrenia Bulletin, April 22, 2015, sbv053. doi:10.1093/schbul/sbv053. (Full text)
