A NEW STUDY has suggested that the risk of schizophrenia and bipolar disorder may be detectable years before the illnesses begin.
The study, published in the journal World Psychiatry, found that 50% of people who developed these mental health disorders had attended a specialist child and adolescent mental health service (CAMHS) during childhood.
The research was led by the School of Medicine at University College Dublin (UCD) in conjunction with the Finnish Institute for Health and Welfare (THL). It was funded by the Health Research Board.
Researchers used Finland’s healthcare registers to trace all individuals born in 1987 throughout childhood and adolescence to see if they ever attended CAMHS between birth and 17-years-old.
Using unique patient identifiers, the researchers were then able to follow these individuals up to 28 years old, and see who went on to be diagnosed with schizophrenia or bipolar disorder.
Of the 55,875 people included in the sample, 7,011 (12.5%) had one or more contacts with CAMHS in childhood or adolescence, while 2,261 (4%) had at least one inpatient CAMHS admission.
Researchers found that the risk of psychosis or bipolar disorder by the age of 28 was 1.8% for individuals who had not attended CAMHS.
The risk for individuals who had attended outpatient CAMHS in adolescence was 15%, and for individuals who had been admitted to an inpatient adolescent CAMHS hospital, the risk was 37%.
At least half (50.2%) of all individuals diagnosed with these mental health disorders by the age of 28 had, at some point in their childhood or adolescence, attended specialist CAMHS.
Of these cases, 16.6% were diagnosed within three months of first attending outpatient CAMHS or on first inpatient CAMHS admission. For the remaining 83.4%, the median time from first CAMHS contact to diagnosis was six years.
“Overall, these findings highlight an enormous untapped potential for prediction of psychosis and bipolar disorder within already existing specialist paediatric mental health services,” the study states.
Schizophrenia and bipolar disorder affect around 65 million people worldwide. Both disorders are usually diagnosed in adulthood and are often associated with high levels of disability, personal and societal cost.
However, early intervention is known to lead to better outcomes for people affected by these illnesses.
Professor Ian Kelleher, from the UCD School of Medicine, said that schizophrenia and bipolar disorder can have “a devastating impact on the individuals affected, as well as on their families”.
“Our findings show that half of individuals who develop these illnesses had come to CAMHS at some stage in childhood, typically many years before they developed schizophrenia or bipolar disorder,” he said.
We know that early intervention is key to improving outcomes for people with serious mental illness. These findings demonstrate the enormous opportunities to provide far earlier intervention, even while still in childhood, by developing specialist early intervention services within existing child and adolescent mental health services.
Stressing the importance of early intervention, Kelleher said: “We know it’s crucial to intervene as early as possible to prevent some of the worst effects of these illnesses. But ideally, we would like to be able to intervene even before the onset of illness, to prevent it altogether.
“These findings highlight the possibility of intervening far earlier than we do at present, even in childhood and adolescence, to prevent these serious mental illnesses from emerging.”
THL Professor Mika Gissler said the research shows “the power of electronic healthcare registers to answer important questions about human health and disease”.
“It demonstrates how healthcare register data can be used to better understand pathways to serious mental illness, from childhood into adulthood, and to identify critical opportunities for early intervention,” he said.
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