sciencemag.org SCIENCE 856 17 NOVEMBER 2017 • VOL 358 ISSUE 6365
Rachel Loewy was an under- graduate in 1995 when she an- swered a flyer seeking students to assist with a research study. A coupleoffloorsupinapsychology department building, Loewy sat, clipboard in hand, interviewing teenagers whose brain health was beginning to falter. Some heard
whispers. Others imagined that their teachers could read their minds, or that fellow
students stared at them and wished them
harm as they walked down the halls.
The teenagers had been diagnosed with
schizotypal personality disorder, a condition that can precede schizophrenia. Among
the most debilitating and stigmatized
psychiatric diseases, schizophrenia can rob
sufferers of their self and their future, often
in early adulthood.
Although these teens didn’t have schizophrenia, the researchers believed that some
would later deteriorate and be diagnosed
with the disorder. But when Loewy met
them they were lucid and self-aware. And
they were frightened that their mind sometimes spun out of control.
“These kids know something is not right,”
Loewy says. “They say, ‘I’m hearing things,’
and it freaks them out.”
Through her mentor, psychologist Elaine
Walker at Emory University in Atlanta,
Loewy also met middle-aged adults with se-
vere schizophrenia who struggled to main-
tain their grip on reality and couldn’t carry
on a conversation. She was struck by the
disparity between the 15-year-olds and the
50-year-olds, and wondered about the path
from early foreboding to serious illness.
“Can’t we do something?” she asked herself.
More than 20 years later, Loewy is a
psychologist at the University of California, San Francisco, and that question has
defined her career. With a small group
of brain experts worldwide, she is trying to bring prevention to the field of
psychiatry—one of the few medical specialties that hasn’t managed to incorporate it.
Doctors routinely assess a patient’s risk of
heart attack, various cancers, and diabetes,
often intervening to slow or stop disease
before it strikes. But preventing psychiatric
conditions, from anxiety to depression to
schizophrenia, has received scant attention.
The reasons are many. “With all due re-
spect to cardiologists,” the brain “is a very,
very complex organ,” says Jacob Vorstman,
a Dutch pediatric psychiatrist who relocated
this fall to The Hospital for Sick Children
in Toronto, Canada. There, he’s setting up a
clinic to assess and follow young people ge-
netically at risk of psychiatric disorders, in-
cluding schizophrenia. Though the brain is
better understood than it was a generation
ago, Vorstman says, how its intricate dance
of chemical and electrical signals gives rise
to mind and personality remains mysterious.
Stigma is also a powerful barrier to prevention. Schizophrenia is marked by episodes of psychosis as well as cognitive and
social problems, and it’s deeply feared and
often misunderstood, even by many physicians. That makes it ethically dicey, some
believe, to label young people at risk when
not all of them will develop the disease. “It’s
easier to say, ‘I am a patient with asthma,’
than to say, ‘Listen, I have psychotic
breaks,’” Vorstman suggests.
But change is afoot. In recent years,
brain specialists have refined their ability
to anticipate who’s at highest risk of psychosis—a defining feature of schizophrenia—
identifying subtle signs in some children
and more vivid precursors in late adolescence. And increasingly, researchers feel
they’d be derelict not to pursue prevention.
Tests of preventive measures are up and running, ranging from cognitive therapies to
pregnancy supplements for the fetal brain
to psychiatric drugs. Last month, a Ger-
By Jennifer Couzin-Frankel
Scientists are learning to
predict psychosis years in advance.
Now, they want to prevent it
A CHANGE OF MIND