Children at risk for schizophrenia

Prevention of schizophrenia: can it be achieved?

Schizophrenia is a serious mental disorder with a profound impact on patients, their caregivers and society. It is also an expensive disorder to treat, despite being relatively rare. In this paper, prevention of schizophrenia is described in terms of primary, secondary and tertiary prevention. Schizophrenia is regarded as a neurodevelopmental disorder with different phases. Primary prevention essentially involves education programmes about the association of obstetric complications and the increased risk of schizophrenia. Secondary prevention involves intervention at the prodromal phase. We review the literature and discuss the evidence relating to intervention in this phase of the illness. Early intervention could result in reduction in morbidity and better quality of life for the patients and their families. The prodromal phase can now be identified, based on current symptoms, with reliability and predictive validity for the risk of development of schizophrenia in the following year. We also discuss possible risks faced by prodromal patients, such as unnecessary stigmatisation, and the role of drug treatment during intervention at this stage. Any recommendation that anti-psychotic medications be routinely prescribed in this phase should be supported by more research work. Drug and psychosocial intervention is indicated as part of tertiary prevention to prevent further disability in the illness.

The health education needs of families caring for a schizophrenic relative and the potential role for community psychiatric nurses

Community care policies for the mentally ill rely, to a large extent, on the informal contribution that often seems to be made willingly by families. In financial terms alone, it has been calculated by the British Government that families caring for a relative with schizophrenia at home save the country 25 billion pounds a year. Nearly 15 years ago, it was argued that community mental health services were failing to monitor the relationships in homes where this situation prevailed and provide the support mechanisms that were required. Further, it has been noted that when there is an over-emphasis on community care, family crises can become severe and remain undetected. This paper reviews the literature relating to the needs of families caring for a schizophrenic relative at home. It concludes that a major service that should be offered to families is education about the illness, schizophrenia, itself. Strategies for undertaking this role are examined within the overall context of 'psychosocial interventions' and the literature on 'high expressed emotion'. Finally, an experimental course, funded by the Department of Health, and located in the Department of Nursing at Manchester University, is described. Here, community psychiatric nurses are being taught to recognize the value of health education for those living with a schizophrenic relative. As a consequence, a number of valuable initiatives have been developed and these are briefly outlined.