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An Ounce of Prevention

Five substances are being used or tested to keep prodromal symptoms from progressing into schizophrenia, but the risk-benefit ratios are still being worked out.

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Chemical (Trade name): Olanzapine (Zyprexa)
Drug class: Atypical antipsychotic (distinguished from typical counterparts by a reduced tendency to cause neurological side effects)
Notable risks: Insulin resistance, weight gain, type 2 diabetes, elevated cholesterol
Possible benefits: Data suggests that this drug—the only antipsychotic tested in a prodromal clinical trial—produces a 2.5-fold decrease in the risk of psychotic conversion; however, the treatment group’s marginal sample size renders the results inconclusive.

Chemical (Trade name): Aripiprazole (Abilify)
Drug class: Atypical antipsychotic
Notable risks: Nausea, insomnia, restlessness
Possible benefits: Post-market surveillance of this drug, used in the PIER schizophrenia-prevention program, suggests a lower risk of metabolic side effects (including weight gain and diabetes) than that posed by olanzapine.

Chemical (Trade name): Ziprasidone (Geodon)
Drug class: Atypical antipsychotic
Notable risks: Slowed cardiac conduction, insomnia
Possible benefits: Poses less risk of metabolic side effects but has been known to cause weight loss. Prodromal clinical trial in planning stages.

Chemical (Trade name): D-serine
Drug class: Notable risks: Possible kidney damage (based on research in rats)
Possible benefits: May reverse the loss of synapses, a hallmark of schizophrenia. In Phase III trials with schizophrenia patients; clinical trials in prodromal patients in planning stages at three sites.

Chemical (Trade name): Omega-3 (fish oil)
Drug class: Fatty acid
Notable risks: Bleeding at high doses
Possible benefits: Like d-serine, may promote synaptic growth, though there’s conflicting evidence about benefits. One preliminary study detected none; more recent data, however, suggests that omega-3 significantly reduces risk of psychotic conversion.

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Halting Schizophrenia

After symptoms begin but before reality departs, aggressive treatment may forestall the disease. But is the intervention worth the risks?

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