Secondary prevention of schizophrenia: utility of standardized scholastic tests in early identification.

BACKGROUND

Given the enormous societal burden of schizophrenia, there has been a growing interest in its prevention during the past decade. Early detection and prompt treatment may improve outcome in schizophrenia. In this study, we examine the value of using pre-morbid cognitive impairment in early detection.

METHODS

Standardized achievement tests Iowa Test of Basic Skills (ITBS) and Iowa Tests of Educational Development (ITED) at Grades 4, 8 and 11 were examined in 70 patients with schizophrenia and 147 comparison subjects without schizophrenia. The majority of comparison subjects later developed another major mental illness such as substance abuse or mood disorder. Receiver operating characteristic curves were used to test the efficiency and accuracy of pre-morbid cognitive tests for differentiating adolescents who will later develop schizophrenia from those who remain well or develop another mental illness.

RESULTS

Although schizophrenia patients had lower mean percentile ranks than comparison subjects in every ITBS/ITED sub-test, these differences were only associated with small increases in risk for schizophrenia. Standardized scholastic tests achieved moderate sensitivity and specificity, and enhanced the detection of schizophrenia by three to five fold. However, positive predictive values were low. ITBS/ITED scores alone cannot be used in screening the general population, given the low positive predictive values.

CONCLUSION

Combining ITBS/ITED scores with other risk factors, such as family history, may lead to more efficient early detection. Our findings illustrate the challenges facing the secondary prevention of schizophrenia. Priority should be given to developing efficient and accurate methods of early detection in order to reduce the dangers of making erroneous false positive diagnoses, and to decrease exposure to unnecessary treatment during the testing of early interventions.