From The Quarterly, Spring 2014

A team of scientists led by co-winners of the Foundation’s 2009 Lieber Prize for Outstanding Achievement in Schizophrenia Research, Raquel E. Gur, M.D., Ph.D., and Ruben C. Gur, Ph.D., and including 2010 NARSAD Young Investigator Grantee Theodore Satterthwaite, M.D., have devised a new method called cognitive growth charting to determine when, during childhood, early symptoms of schizophrenia and psychosis can show up and with what intensity.  

This new work, published online February 05, 2014 in the journal JAMA Psychiatry, is important for several reasons. It has been widely demonstrated that early intervention in psychiatric illness improves outcomes. In psychotic disorders in particular, if the illness can be identified and treated prior to full blown psychosis, the chances of effectively treating the illness are greatly increased. There are currently, however, no biological diagnostic tests (such as a blood test for diabetes or an EKG for heart disease) that effectively predict psychosis. It remains very challenging for parents, patients and even medical practitioners to predict and identify when psychiatric illness is in early development.

The research team at the University of Pennsylvania first conducted studies on a large sample of about 10,000 youths aged eight to 21 who were seen at the Children’s Hospital of Philadelphia for general pediatric services. For this current study, they focused on over 2,000 children and adolescents with psychotic symptoms; all of the children were genotyped and then evaluated with a one-hour computerized battery of cognitive tests. The team was able to develop a statistical measure indicating whether and by how much a given participant lagged in neurocognitive development, compared with individuals demonstrating healthy development.

The study results reveal that children who have psychotic features begin to show signs of neurocognitive delay very early. Cognitive performance suggestive of developmental delay was evident at age eight. The growth charts suggest delays across neurocognitive categories. After age 16, the divergence becomes wider.

“Our study demonstrates that both cognitive delay and psychotic symptoms co-occur and are detectable at an early age,” the team reports. The developmental delays were similar in affected males and females. Those with more pronounced symptoms of psychosis showed a greater developmental lag. Females had less severe and later onset of symptoms, on average.

Much more research is needed on what is called the “prodromal”* (early developmental) stage of schizophrenia and other brain and behavior disorders. But this work makes an important step forward in detecting irregular brain development at an early age that could greatly facilitate detection of psychiatric illness in development—rather than having to wait for the full blown illness to manifest.

TAKE AWAY: A new method of measuring cognitive and emotional development in youth may greatly increase possibilities for early intervention in mental illness.