How Can I Reduce My Risk of Schizophrenia?

Reader’s Question

My late brother developed schizophrenia when he was 17. His case was severe, and although we found a medication that worked very well for him, whenever he began to recover, he would want to return to heavy drug usage (which his doctors, and I, believe triggered his illness). He committed suicide at 19. I am two years younger than him, currently 21, and I have no symptoms of schizophrenia. But, of course, it worries me from time to time that it could happen. I’m a woman, and I’ve heard that women develop the illness later, on average, than men. Because of his case, I avoid drugs for the most part. I know that, being his sibling, my risk is higher. I have no history of mental illness myself, and I’m healthy, but I want to be sure I’ve got my bases covered. Is there anything I can do to limit my risk?

Psychologist’s Reply

I am sorry to hear of the loss of your brother. I imagine that was quite a difficult time for your family.

Schizophrenia is known as a “thought disorder” because many of the symptoms are related to trouble with thinking and perceiving reality accurately. Examples of this are hallucinations (e.g. seeing or hearing something that is not there) and delusions (false beliefs). Schizophrenia.com, a non-profit source of information and support, provides the following list of symptoms and signs:

• changes in perception
• unusual thoughts
• odd behavior
• social withdrawal
• loss of interest or lack of motivation
• trouble thinking clearly
• changes in sleeping or eating patterns
• less concern with appearance or clothes
• feeling suspicious of others
• feeling like things are unreal

You are right that having a sibling who was diagnosed with schizophrenia means that your risk is higher (approximately 1 in 10) than the general population (approximately 1 in 100). According to Dr. Jeffrey Lieberman, the chairman of the psychiatry department at Columbia University College of Physicians and Surgeons, and director of the college’s Lieber Center for Schizophrenia Research, schizophrenia is also influenced by environmental factors. Early environmental factors that can predispose people to later developing schizophrenia include drug use, malnutrition, or illness during the mother’s pregnancy, or oxygen deprivation at birth. Factors later in life that can increase risk are use of recreational drugs during adolescence (especially marijuana), and extreme stress. So, what this means is that the risk is higher when a genetic predisposition is combined with certain events (e.g. stress).

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Some studies have looked at the association between infections and schizophrenia. The New York Times Health Guide provides information about causes of schizophrenia. A recent study confirmed an association between toxoplasmosis (a parasite found in cats and other animals) and schizophrenia, and also lists other risk factors (Torrey, Bartko, & Yolken, 2012).

Schizophrenia.com offers a list of “risk reduction strategies.” According to this site, the general belief is that schizophrenia is caused by a combination of genetic vulnerability plus early environmental stressors that affect the brain. What you do or experience later in life (e.g. as a teen or adult) can either lessen the effects of this early exposure and/or genetic predisposition, or exacerbate it. The first recommendation is to avoid the use of street drugs, and to use alcohol only in moderation. So, it seems as if you are already on the right track! Other than that, the recommendations appear to focus on strengthening social connections, and managing stress and anxiety as best you can.

In general, it would appear that there are no guarantees with regard to preventing schizophrenia. However, as with anyone, it would seem that your best bet is to learn how you can manage your own stress, stay connected with others, and seek help if you do begin to experience unusual thoughts or difficulties with reality perception. If you do become concerned, Schizophrenia.com also offers a list of clinics around the world that specialize in the early diagnosis and treatment of psychosis, and a video about early diagnosis. There are 15 clinics in the U.S.

Treatment of schizophrenia has been well researched, and many articles can be read online in the archives of the Schizophrenia Bulletin, an academic journal. All articles but those from the current year are available free online. You will see many studies about antipsychotic medications, which are effective for many in managing symptoms. In addition, a 2007 study found that cognitive therapy helped maintain stability and prevent psychosis in a high-risk sample of people (Morrison, et. al.).

As with many mental health problems, prevention begins with attending to and maintaining your physical and emotional health.

References:
Torrey, E. Fuller; John J. Bartko & Robert H. Yolken (2012) ‘Toxoplasma gondii and Other Rrisk Factors for Schizophrenia: An Update’, Schizophrenia Bulletin 38(3): 642-647.

Morrison, Anthony P.; Paul French, Sophie Parker, Morwenna Roberts, Helen Stevens, Richard P. Bentall & Shon W. Lewis (2007) ‘Three-year Follow-up of a Randomized Controlled Trial of Cognitive Therapy 
for the Prevention of Psychosis in People at Ultrahigh Risk’, Schizophrenia Bulletin 33(3): 682-687.