Spotting Early Warning Signs of Psychosis

Schizophrenia, a debilitating disorder characterized by hallucinations, intrusive thoughts, and illogical behaviors, affects about 1% of the population. That might sound like a small number, but to psychologist Vijay Mittal, it isn’t small at all – and neither are its consequences. “In a room of 100 people, one is likely to have schizophrenia and several more are related to someone with the disorder,” Mittal points out. “We don’t talk about it very often, but it is so detrimental to people’s lives.”

Schizophrenia is complicated to treat, and it isn’t typically thought of as preventable. But that’s changing, thanks in part to Mittal, who is an assistant professor at Northwestern and the head of a clinic called ADAPT. Mittal and his colleagues have identified early warning signs of schizophrenia that can be spotted in young people before they develop full-blown psychosis. That kind of early identification opens the door to early treatment, which may one day prove to be effective in mitigating or even preventing future onset of psychotic disorders.

Scientists have long known that schizophrenia, which typically appears in late adolescence or early adulthood, is triggered by a combination of genetic factors and environmental stressors. In recent years, they have also learned that its onset can sometimes be predicted by early symptoms, like seeing or hearing things that aren’t there. But not everyone who has those symptoms will go on to develop the disorder, so it’s not feasible to prescribe antipsychotic medications for everyone (a standard therapy, which can cause serious side effects), and other approaches like psychotherapy may be costly or unavailable.

What if there were other, more predictive early warning signs?, Mittal wondered when he started his graduate work. Through a combination of behavioral, biological, and neurological studies, he has found that indeed there are. That has allowed him to identify a group of people who are most likely to develop serious symptoms from among the pool already known to be vulnerable based on factors like family history of the disorder, trauma, and atypical thoughts and behaviors.

One of the risk factors Mittal has studied is unusual motor behavior – subtle physical patterns like coordination problems and involuntary jerking movements. His graduate advisor had discovered that some individuals with schizophrenia had shown such movements even as infants and children, using an innovative method of reviewing childhood home movies.

Mittal probed the brain science behind the connection in order to study whether the irregular motor behaviors could differentiate among at-risk adolescents who would later have psychotic disorders and those who wouldn’t. “The same basal ganglia brain circuit that governs motor behaviors is highly implicated in schizophrenia,” he says, explaining that individuals with schizophrenia tend to have irregularities in a neurotransmitter called dopamine in that part of the brain. So if you see the unusual physical movements, it’s logical to begin looking for the early cognitive signs of schizophrenia, he hypothesized. And that’s just what Mittal found: when he studied at-risk young people, those who exhibited the unusual movements were several times more likely to develop psychotic behavior than those without them.

Applying findings from other fields to psychosis research has become something of a hallmark of Mittal’s career. He teamed up with researchers looking at how handwriting patterns can mark a variety of disorders and showed that subtle handwriting abnormalities can also predict schizophrenia risk. He is now working to assess the potential for tablet-based handwriting assessments for young people at high risk, “the kind of assessment anyone can do,” he hopes.

He is also testing whether exercise can help prevent schizophrenia in at-risk populations. That work was inspired by studies showing that exercise can reduce memory loss by way of new cell growth in a part of the brain called the hippocampus. Around the time he read those findings, Mittal’s own studies were finding abnormalities in the hippocampus of adolescents at-risk for schizophrenia, so he hypothesized that exercise could help them, too. The preliminary results are promising.

Mittal hopes that his work will allow for both better early identification of psychosis and treatments for it.  He is passionate about translating his research into interventions, and he works with primary care physicians and schools to help them identify ultra-high-risk individuals. His work offers hope for researchers, doctors, and most importantly, schizophrenia patients and their loved ones.


mittal_photoVijay Mittal is a recipient of the Federation of Associations in Behavioral & Brain Sciences (FABBS) Early Career Impact Award, presented during the annual meeting of the Society for Research in Psychopathology in Baltimore, Maryland.