. "4 Using a Developmental Framework to Guide Prevention and Promotion." Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington, DC: The National Academies Press, 2009.
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Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities
have the potential for reducing the overall population rate of schizophrenia (Geddes and Lawrie, 1995). Malnutrition (Susser, Neugebauer, et al., 1996), hypoxia, or infection (Pearce, 2001) are thought to have an adverse effect on the neurodevelopment of the fetus. Thus, ensuring good prenatal care (and reducing maternal rubella infections in developing countries) for all expectant mothers is a universal prevention strategy for schizophrenia to be investigated. Another selective strategy might be aiming supportive interventions to those born with obstetric complications.
Screening for developmental difficulties through multiple stages of life may be appropriate among children born with obstetric complications or whose family history suggests high risk (Brown and Faraone, 2004). Data from studies of high-risk groups suggest that nearly all those with affected family members who later have a diagnosis of schizophrenia had attention problems in childhood as well as diagnoses and difficulties in meeting the important task demands at successive stages of life (Mirsky, Yardley, et al., 1995; Weiser, Reichenberg, et al., 2001).
Identification of the prodromal stage of schizophrenia may present an opportunity to intervene (McFarlane, 2007). Indeed, there are a number of trials currently under way that use low-dose atypical antipsychotics, often in combination with family-focused psychosocial interventions, to prevent the onset of a first episode of psychosis in adolescents and young adults with prodromal symptoms (see Chapter 7). Another promising line of research involves identification and potential intervention among youth and young adults who have underlying signs and symptoms suggesting a genetic liability for schizophrenia without full manifestation of symptoms. The term “schizotaxia” represents a nonpsychotic construct with signs of brain abnormalities and some degree of cognitive, neuropsychological, and social impairment. Such a constellation of negative symptoms and neuropsychological deficits is common among unaffected first-degree relatives of those with schizophrenia (Faraone, Biederman, et al., 1995; Faraone, Kremen, et al., 1995). Particularly relevant for prevention is some evidence that schizotaxia symptoms among adults are ameliorated with low-dose resperidone (Tsuang and Faraone, 2002). Despite major challenges in nosology and ethical considerations regarding labeling and intervention among young people, this line of research holds promise as a strategy for preventing schizophrenia.
Substance abuse and dependence tend to emerge in mid-to-late adolescence and to be more common among boys. Substance abuse is greater among young people who experience early puberty, particularly among girls. It is widely accepted that children of drug and alcohol abusers are