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Schizophrenia is a psychiatric disorder that includes complex and diverse symptoms.

Schizophrenia is a psychiatric disorder that includes complex and diverse symptoms. Many of these symptoms overlap with other psychiatric disorders, and these symptoms can frequently change during the progression of the disorder. Schizophrenia includes positive symptoms (symptoms that seem to represent an excess or distortion of normal function) and negative symptoms (symptoms that seem to represent a reduction or loss of normal function). Positive symptoms include delusions, hallucinations, inappropriate affect, incoherent speech or thoughts, and odd behavior. Negative symptoms include affective flattening, alogia (reduction or absence of speech), avolition (reduction or absence of motivation), and anhedonia (inability to experience pleasure).

Some research suggests that schizophrenia may be related to developmental abnormalities in the brain. Clues may be found in the rest of the body as well. Prenatal development includes critical periods when organs and structures are going through rapid growth and cell division. During these periods, the cells are more susceptible to damage. One might expect that if there is a period of damaging influence, several structures might be damaged, including those responsible for schizophrenia.

Scientific evidence also points to a possible link between schizophrenia and altered brain development in the first three months of pregnancy. Babies born with minor physical abnormalities may be at increased risk of developing psychological problems such as schizophrenia - especially if one or both of the parents suffers from schizophrenia. For example, a study published in the American Journal of Psychiatry found children who were born with several physical deviations such as wide-set eyes, a high palate, low-set ears, or a curved fifth finger, among other anomalies, were more likely to suffer from schizophrenia-related disorders than no mental illness at all. Those with a high number of slight physical irregularities were also more likely to suffer from schizophrenia than other mental problems. One idea about the basis of schizophrenia, which has developed over the last 15 years, is that there is an early insult in the first trimester of pregnancy that basically pushes brain development in a somewhat aberrant direction.

Given this risk for the development of schizophrenia, there are currently several clinical trials investigating whether pretreatment with antipsychotic drugs in individuals at risk for developing schizophrenia will prevent the onset of the disorder. One idea is that schizophrenia is a direct result of faulty brain pruning that occurs during early adolescence. Perhaps this faulty brain pruning is tied to early risk factors, though scientists are not sure. While these studies continue, they remain controversial. To give you a sense of the controversy surrounding such research, read this Wall Street Journal article about such research here. If you cannot access the WSJ article, you can also read more here from NPR. Even with the controversy, the results seem promising. For example, see here and here. Given your understanding of schizophrenia and the risks/benefits associated with antipsychotic mediations, think about the following questions:

1. What are the potential benefits of this sort of approach where antipsychotic drugs are administered to those at risk for developing a psychiatric disorder, given the poor life-time prognosis of schizophrenia?

2. What do you think are the potential disadvantages of this approach given the potential side effects of these drugs and other unknown effects?

3. If you had a child who was at risk for developing schizophrenia, would you allow your child to be pretreated with antipsychotic medications to help delay or stop the onset? Why or why not? 

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