The Ethical Challenges of Early Intervention in Psychosis


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)


  1. If its drug intervention this could create “schizophrenia”.

    The only “schizophrenia” I know was that of a drug induced disability nature.
    This disability came to an end when I stopped taking ‘medications’ with decent non drug help – and it didn’t come back.

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  2. “administering antipsychotic medications “to a group of adolescents, the majority of whom will not progress to schizophrenia.””

    Oh, I’m sure if they do that a lot more of them will “progress”. Which in turn will be used as proof they were right all along and prompt: “we wish we could have caught them even earlier”. I wonder when they will start adding this shit to drinking water.

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  3. The fortune tellers fears will come true if people believe the lie.

    “The best way to predict your future is to create it.”

    “People are stupid; given proper motivation, almost anyone will believe almost anything. Because people are stupid, they will believe a lie because they want to believe it’s true, or because they’re afraid it might be true. Peoples’ heads are full of knowledge, facts and beliefs, and most of it is false, yet they think it all true. People are stupid; they can only rarely tell the difference between a lie and the truth, and yet they are confident they can, and so are all the easier to fool.”

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