Following Emil Kraepelin’s description of Dementia Praecox as a progressive deteriorating disease, Swiss psychiatrist Eugen Bleuler reported on his experience with these patients at the Burghölzli Sanatorium in his book, Dementia Praecox, or the Group of Schizophrenias, published in 1911. He described a variable not so pessimistic course of illness and posited a particular personality type, the Schizoid Personality, that antedated the outbreak of illness. While this premorbid personality is frequently apparent in retrospect, prediction going the other way [who will develop psychosis?] hasn’t been easily achieved. Back during the DSM-5 Task Force deliberations, there was much ado about the Attenuated Psychosis Syndrome [nee Psychosis Risk Syndrome] – new names for a century old concept.
Could the patients who were going to become psychotic be identified with any accuracy?
If they could, what would we do about it?
So Dr. Lieberman’s video above is just one of many videos and articles he’s produced over his presidential year on the topic. I can’t find that there’s any more solid evidence that they are closer to accurate predictions or promising interventions than they were in the summer of 2011 when they jumped on this bandwagon. Which brings me to this article in the PsychiatricNews:
PsychiatricNewsby Mark MoranApril 18, 2014
The psychoanalytic method and highly individualized treatment approach at Chestnut Lodge pointed toward the contemporary focus on early detection and intervention…
During the 1980 revolution in psychiatry, Chestnut Lodge stood as a symbolic bastion of psychoanalytic treatment – on the other side from the wave of psychopharmacologic treatment. The patient, Dr. Osteroff, was admitted to Chestnut Lodge in 1979 and treated for seven months with intensive psychotherapy, diagnosed as having a personality disorder. His condition worsened over that hospitalization, and he was transferred to another facility where he rapidly responded to medication. The details are here:
And yet ironically, it was also the years of analytic work with patients with psychosis at the Lodge that had helped point McGlashan in the direction of early detection and intervention in the “prodromal” phases of the disorder — a movement that is now the leading edge of schizophrenia research. For it was the rich case histories of countless patients at the Lodge that provided the clearest evidence that in almost every case, signs of trouble had been apparent sometimes years before an acute psychotic episode. “That’s what really taught me that there is this psychosis risk period, that it’s very distinctive and that it’s lengthy,” McGlashan said. “I decided that that’s where we have to intervene. And when I left the Lodge [in 1990] that became the focus of all my work.”
Today, Heinssen is the National Institute of Mental Health’s science officer for the North American Prodrome Longitudinal Study, a nine-site consortium of clinical research programs dedicated to the early detection and prevention of psychotic disorders and other forms of serious mental illness. McGlashan has been a leading investigator in the ongoing Early Treatment and Intervention in Psychosis (TIPS) study in Scandinavia, and developed the Scale of Prodromal Symptoms, which is used to assess at-risk individuals for inclusion in early-intervention programs.
The Bullard family sold the Chestnut Lodge property in the 1990s, and the hospital closed in 2001. The property changed hands several times before a developer purchased it with the intention of converting the property into condominiums; but on the morning of June 7, 2007, the main building burned to the ground under mysterious circumstances. Its ruins — the old cottage where Fromm-Reichman lived still stands — persist as a monument to an extraordinary and heroic effort to understand the individual behind the psychotic disorder, an individual with a history and a human story that might have taken a different turn.“There were some phenomenal teachers and therapists there,” Heinssen said. “To the uninitiated, people with psychosis can appear alien, and it is no surprise that they get pushed away. There is something extraordinarily unsettling about interacting with someone who experiences a different reality. But at the Lodge there were many heroic doctors and nurses who sought to find the human being behind the disease. They taught me to look beyond psychotic symptoms and to connect with the real person who has a soul and value and worth.”