Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 215The potential for causing harm by educating people about obstetriccomplications and increasing access to prenatal care appears very limited.Maternal and infant health and survival should only be improved, regardless ofwhether the infant was at increased risk for schizophrenia or not. To avoidcreating undue personal concern or stigma, educational efforts should make itclear that the risk to a person who is a first-degree relative of someone withschizophrenia of bearing a child who will develop the illness is not frighteninglyhigh. The risk is increased from the general population rate of one per cent toaround four or five per cent. 99INTERVENTION WITH THOSE “AT-RISK” FORSCHIZOPHRENIAThere is current interest in the possibility of reducing the incidence ofschizophrenia by treating people who have some premorbid features of the illnessor other risk indicators prior to developing the full syndrome. The excitement hasbeen generated, in large part, by the work of Australian psychiatrist PatrickMcGorry and colleagues at the Early Psychosis Prevention and InterventionCenter (EPPIC) in Melbourne and by a project pursuing the same line of researchlaunched by American psychiatrist Thomas McGlashan at Yale University. Articlesin the New York Times, 100 research newsletters 101 and other media sources havepublicized the approach, and the governments of Great Britain and Australia andhealth regions in Italy and Canada have listed it as a public health priority. Is suchenthusiasm supported by the research and epidemiological data? Unfortunately not.According to psychiatric epidemiologist Assen Jablensky, 102 if a screening andearly treatment program for any illness is to do more good than harm, the answerto each of the following questions must be “Yes.”• Does the burden of disease warrant screening?• Is there a good screening test?• Is there an effective preventive intervention?• Will the program reach those who would benefit?• Can the health-care system handle the screening?• Will the screen-positive individuals comply with the proposed intervention?In the case of schizophrenia, the answer to the first question is a resounding“Yes,” but to the remainder the answers are “No” or, at best, “Doubtfully.”Adequate screening measures and effective interventions are not yet available.The most promising current screening measure—one devised by JoachimKlosterkötter and co-workers in Bonn, Germany, 103 which detects prodromalsymptoms of disturbance in thought, perception, and other areas of functioning—if applied to the general population, would be accurate a mere two per cent of thetime. 104 This means that 98 of 100 people labeled as likely to developschizophrenia by the Bonn measure would be false positives -not in fact at risk for