Early Recognition and Intervention Program for Psychosis and Bipolar Disorders

The Zurich Program for Sustainable Development of Mental Health Services (ZInep) aims to align psychiatric care in the Canton of Zurich more ideally with the needs of mentally ill people. The sub-project “Early Recognition” is one of several ZInep projects.

Over the past few years, the course of schizophrenic psychoses and bipolar disorders has considerably improved. Thanks to new treatment options, many patients are able, to a large extent, to lead a normal life. However, with some people the initial symptoms are not properly recognized. Lack of treatment or a delay in the start of treatment can then lead to an unfavorable course of the illness or even to the illness becoming chronic.

A requirement of systematic prevention is to correctly identify people with a real and increased risk of psychosis. Within the framework of the ZInEP Early Recognition Project several early recognition centers in the Canton of Zurich are to be set up. Young people between the ages of 13 and 35 who show the first signs of a mental decompensation can go there in order to clarify whether they have an increased risk of developing a psychosis.

Based on scientific studies, it is assumed that schizophrenia has neuro-biological origins, that is to say that the causes of this illness are found in the brain. The illness presumably has its origins in the embryonic period, during which the coincidence of various risk factors, such as a gene of predisposition (susceptibility gene), deformities of nerve cells in the brain (migration defect), and stress before or during birth cause a vulnerability of the brain. When biopsychosocial influence factors interact with stress occurring in adolescence or adulthood, the threshold for developing a psychotic disorder is lowered.

The ZInEP Early Recognition Project offers a thorough medical and psychological assessment based on the most up-to-date scientific research. As part of this, so-called clinical signs or indicators of increased susceptibility (vulnerability) to the risk of a schizophrenic or bipolar illness are examined and incorporated into the clinical diagnostics. These are, among others, neuro-psychological indicators (e.g., cognitive malfunctions) neuro-physiological abnormalities in processing information from perceived stimuli (evoked potentials), socio-physiological changes (e.g. empathic capacity), and neuroanatomical changes in the brain.

Some of these susceptibilities are argued as being stable character traits, that is to say independent of condition. For that reason, genetic components and possible family predispositions to psychotic and bipolar disorders are also examined. As well as early recognition, the program offers extensive counseling for people affected as well as family members. Early treatment of the underlying symptoms, either psychological or with medication, could contribute to a key improvement in the course of the illness. Scientific studies prove that early treatment significantly lowers the transition rate to schizophrenic psychoses or bipolar disorders. Moreover, symptoms can be reduced and an improvement in the level of social functioning can be achieved.

The research project is supported by a foundation and is being carried out at the Psychiatric University Hospital Zurich, at Kilchberg Sanatorium, at the Center for Child and Adolescent Psychiatry and Psychotherapy, and at the Integrated Psychiatric Department of Winterthur in collaboration with the University of Zurich.