Providentia

Encephalon Edition 83 Delayed

Due to technical reasons, the 83rd Edition of the Encephalon Carnival has been delayed until early next year.  Anyone interested in submitting a post can send it to me directly or to Mike Lisneski at mike.lisieski@gmail.com. 

New Study Investigating Concussion in Hockey Players

As part of an ambitious new study investigating the effects of repeated head injuries on athletes, a Toronto-based medical team is requesting that hockey players will their brains to medical science.   The team is headed by one of Canada's foremost experts on concussions, Dr. Charles Tator of Toronto Western Hospital.  Dr. Tator has a longstanding interest in acute spinal cord and brain injury as well as founding the Canadian branch of the Think First Foundation (thinkfirst.ca) to increase awareness of the debilitating effects of brain and spinal injuries.   Dr. Tator's research team consists of some of Canada's most prominent neurosurgeons, neuropathologists,  and other health professionals and is intended to gather information on the impact of repeated head injuries in hockey players.   Patterned after a Boston-based research project investigating the brains of professional football players, Dr. Tabor hopes that professional hockey players will agree to will their brains to science as they become aware of the program

Although the potentially devastating consequences of sports concussions are well-documented in professional boxers and wrestlers, similar findings are just beginning to be recognized in other sports.    The  research results from the Boston project involving football players have already shown that chronic traumatic encephalopathy resulting  from sports concussions can lead to long-term problems such as chronic headaches, personality changes, depression, and even dementia.  As an outspoken critic of aggressive hockey playing and the traditional practice of ignoring potentially dangerous concussions, Dr. Tator has pointed out that better aftercare is needed after even apparently minor head injuries.   In a recent seminar given this year, Dr. Tator and other experts from the Think First Foundation warned coaches, trainers, parents, and hockey players that  serious concussion may not lead to loss of consciousness (duration of unconsciousness has tended to be an informal measure of the severity of the head injury).   The seminar also stressed that players should not return to the ice unless they are symptom-free. 

The incidence of  repeated concussions in professional hockey is already a concern in the National Hockey League and shows no sign of subsiding despite increased awareness of the problem and greater precautions on the ice.  This includes the passage of Rule 48 imposing penalties on players for blindside hits aimed at the head of other players.   Awareness has also been raised by high-profile cases involving hockey players who have had their careers seriously derailed by sport-related concussions, including Peter Mueller,  Brett Lindros, and Marc Savard. 

Dr. Tator has stated that the research project is intended to be long-term in nature.  "The way I look at it, we are just at the beginning of a long-term study," Tator said. "It is not going to be over in a year or two, especially when we're talking about developing treatment. We are looking at 10 years on out."   One of the first brains to be donated to the study belonged to football player, Jay Roberts, who died earlier this year. 

For more information

 

 

The Glass King

He is still remembered in history as Charles the Beloved (or Charles the Mad depending on which biography you read).  Even a brief look at the long and tumultuous life of Charles VI  of France shows how he came by both labels.  It's often difficult to get a clear idea of how mental illness was dealt with through the centuries since the mentally ill rarely find their way into history.  Except of course, when mental illness involved heads of state or other politically important people.  When an absolute monarch such as Charles VI went insane, millions of lives could be affected.  

Crowned as King of France in 1380 at the age of eleven, Charles's uncle Philip served as regent for his first eight years as king.  Despite his rule beginning hopefully enough with an arranged marriage to Isabeau of Bavaria, Charles first began experiencing bouts of psychosis in his early twenties.   While no true clinical descriptions of his psychotic episodes exist, it seems likely to have been some form of schizophrenia.  Despite relatively long periods of  normalcy, Charles' condition would worsen over time. 

The first recorded episode,  and probably the most severe occurred on August 5, 1392.  While in pursuit of a fugitive suspected of an assassination attempt, Charles was riding towards the Breton border with his entourage (including his brother and uncles).  He had been drinking heavily the night before and, despite the hot weather, was wearing a thick velvet jacket and coat.  When they reached the forest of Le Mans, a roughly dressed man (possibly a leper) seized the bridle of the king's horse and screamed that the king would be destroyed if he did not turn back.  The entourage forced the stranger to release the bridle and he was driven off without further incident.   As the royal expedition later exited the forest, one of the king's pages accidentally dropped the lance that he had been carrying.  Startled by the sound, Charles drew his sword and shouted, "Forward against the traitors!  They wish to deliver me to the enemy!".  He then lashed out with his sword and killed four of the five knights nearest to him (the number of knights killed varies in different historical accounts) including one of his own noblemen.  His uncle, the Duke of Burgundy, managed to mobilize the surviving knights and they restrained the king before he could do any more damage.  As Charles lay prostrate on the ground, he was struck mute and his eyes were rolling wildly from side to side (possibly an oculogyric crisis).  He had to be taken back to his castle in an ox-cart. 

Although Charles eventually recovered, he would be prone to intermittent attacks of madness for the rest of his life.  His uncles, who had acted as Charle's regents before he reached adulthood, took control of the government.  This eventually triggered a succession crisis since Charles' younger brother, the Duke of Orleans, insisted that he should rule given the king's "absence".  The uncles overrode him but their mutual animosity contributed to the political unrest of that era.  Despite early optimism that Charles' reign would bring a new era of peace for France, his madness instead helped extend the Hundred Years War  (which was actually 116 years long.  Just saying). 

One of the most horrifying events of Charles' reign occurred in January 1393.  As part of a wedding celebration involving one of Isabeau's ladies-in-waiting,  Charles and some of his friends decided to dress up as "wild men" with costumes of linen and hemp soaked in pitch to make themselves look especially hairy and wild.  The  costumed revelers then chained themselves together and danced for the other guests (it probably seemed like a good idea at the time).  Given their highly flammable costumes, all naked flames were banned but the king's brother then appeared with a lit torch as he had been unaware of the nature of the spectacle.  A "wild man" got too close to the torch and his costume caught fire, quickly spreading to the others.  One reveler burned to death on the spot while two others died later.  Only the quick action of a young duchess kept the king from burning to death as well (she threw her skirts over him to douse the flame).  The disaster has gone down in history as "le Bal des Ardents" (Ball of the Burning Men) and likely did little to help the king's already fragile mental state. 

Historical accounts of the various episodes of madness that Charles experienced throughout his reign tend to vary.  At times not even recognizing his queen or other family members, he would often spend nights running through the castle howling like a wolf.  To keep him inside, the queen and his courtiers ordered the entrances to his residence walled up.  Later in life, he would often refuse to bathe or change his clothes.  He even developed the strange delusion that he was made of glass and insisted on protecting himself to keep from breaking.   Much of the responsibility of caring for the ailing king fell on Queen Isabeau who became increasingly unpopular due to her autocratic rule and extravagant habits.

Given the desperate search for anyone who could cure the king's madness, various charlatans offered their services.  In 1397, two Augustinian monks with a reputation as occult experts  declared that the king was the victim of sorcery.    After reciting some incantations, the king had a brief lucid episode and the monks were richly rewarded.  When Charles had the inevitable relapse, the monks accused the king's brother and his barber of casting spells and both were arrested.  After an investigation turned up no evidence of wrongdoing, the monks were tortured and forced to confess that they were sorcerors themselves.  They were tried, beheaded, and their bodies were drawn and quartered.  Amazingly enough, this failed to discourage others from offering their services in curing the king although their luck was no better.

Never well-liked due to her German background and failure to learn proper French, Isabeau became the target of repeated rumours of infidelity.   Whether or not the rumours were true, her husband's paranoia ensured that men kept their distance from the queen.  In 1417, Queen Isabeau was banished because her husband suspected her of having an affair with her grande maitre, Louis de Bostedon.   Although he could do nothing to the queen herself, Charles ordered Louis arrested and imprisoned.  He then had the unfortunate courtier sewn into a leather sack inscribed with the words Laissez passer la justice du roy (Let the king's justice be carried out) and thrown into the river Seine (even insane kings had to be obeyed).  Two years earlier, following the defeat of the French forces at the Battle of Agincourt, both Charles and Isabeau had been forced to sign the Treaty of Troyes which disinherited their son in favour of King Henry V of England and his wife Catherine (who also happened to be their daughter).  Since Charles was considered to be incompetent, most of the blame for that disastrous treaty fell on Isabeau despite the fact that she had no real choice in the matter. 

After Charles' death in 1422, France effectively became an English territory under the rule of Henry V's descendants.  Henry himself had died within a few months of Charles leaving his young son, Henry VI as nominal ruler of both countries.  As it happened, this set the stage for a far more well known story of madness and monarchy involving a teenaged girl named Jeanne d'Arc (a.k.a. Joan of Arc).  Inspired by voices only she could hear which told her to restore France to French rule, Joan would later lead an army that eventually established Charles and Isabeau's son, Charles VII, as King of France.

But that's another story.

Happy Holidays

Happy holidays wishes to you and yours! For those of you who celebrate Christmas, may the day bring you good tidings and glad times. For those of you of other faiths, may the season be a good one for you and your families!

Encephalon Edition 83 Coming Soon

Just to let you know that I'll be hosting the 83rd edition of Encephalon on Thursday, December 30.   Published monthly, this rotating carnival contains some of the best neuroscience and psychology writing on the Web.   Since first being launched in 2006, the carnival has died and been reborn numerous times (which has to be a metaphor for something).

In any event, anyone interested in submitting a post for consideration can contact me directly by email at rvitelli (at) msn (dot) com or on Twitter at @rvitelli.  The post you submit can either be something you've written yourself or just read recently that you feel deserves wider publication.  

If you are interested in hosting Encephalon yourself sometime in the new year, drop a line  to Mike Lisieski of Cephalove at mike.lisieski(at)gmail(dot)com .

The "Separate But Equal" War

In 1951, when a group of thirteen parents  first filed a class-action suit against the Topeka, Kansas  Board of Education over the continuing use of racial segregation, it sparked a three-year legal battle culminating in the fateful Brown vs the Board of Education decision by the U.S. Supreme Court in 1954.   By overturning the 1896 Plessy vs Ferguson decision, the Supreme Court established that the "Separate but Equal" provision permitting racial segregation in American schools represented a clear violation of the Fourteenth Amendment by perpetuating inferior education and treatment for children of African-American descent. 

The plaintiffs of the case, under the direction of the local National Association for the Advancement of Colored People (NAACP), had attempted to enrol their twenty children in nearby schools in the Topeka area.  When the enrolment was rejected with the children being referred to segregated schools (which, in many cases, involved children having to walk six blocks or more just to reach the necessary bus stop),  the plaintiffs (headed by Oliver Brown) were urged to file an action protesting the discrimination.  The resulting "Oliver Brown et al. v. The Board of Education of Topeka, Kansas" trial represented a crucial test of the racial segregation policies that had polarized American society for decades.  It also provided a reunion of sorts for two very different psychologists:  Mamie Phipps Clark and Henry Garrett.

Born in 1917,  Mamie Phipps' childhood  in  racially segregated Hot Spring, Arkansas exposed her to the often deficient primary and secondary education that was considered normal for African-Amerian children of that era.  Since her father was a  physician who had financed his own way through medical school and both of her parents were prominent members of the local African-American community, they instilled the value of hard work and dedication in their children.  Mamie Phipps enrolled at Howard University in 1934 and, while she had originally planned to study physics and mathematics, changed her major to psychology at the suggestion of her future husband, Kenneth Bancroft Clark. 

Along with her psychology studies, Mamie Phipps worked part-time in the psychology department as well as a summer internship with the office of prominent civil rights lawyer, William Houston.  Her work in dealing with the various cases challenging existing segregation legislation left a profound impression on her.  Enrolling as a psychology graduate student in 1938 (and marrying Kenneth Clark at about the same time), she began working with her then-husband  on research examining racial difference in pre-school children.   Her master's thesis,  The Development of Consciousness of  Self in Pre-School Negro Children, inspired her husband to work with her in submitting a joint research grant proposal to the Julius Rosenwald Foundation.  The resulting grant would fund their joint research for three years and also made it possible for Mamie Clark to enter Colombia University to study for her doctorate. 

While her husband continued gathering research data, Mamie Clark plunged into her graduate work and raising their first child.   Despite being  the only African-American student in the Colombia graduate psychology program at the time, she would later report it to be a satisfying experience and denied any real racial issues affecting her studies.  It was at Colombia where she first met Henry Garrett and asked him to be her dissertation professor.  As a prominent statistician, former president of the American Psychological Association, and Chair of Psychology at Colombia, having Garrett as a mentor seemed an obvious choice.   The fact that the was also a eugenicist and a proponent of "race hygiene" did not appear to have any impact on his working relationship with her.  Mamie Clark graduated with her doctorate in 1943 after completing her research on identity in black  children.

Despite the meagre job opportunities available following her graduation, Mamie Clark and her husband established the Northside Center for Child Development in 1946.  From its humble beginning in a Harlem basement apartment, the Center provided a homelike environment for minority children to help supplement the practically nonexistent community resources available at the time.  Acting as director, Mamie Clark oversaw a range of services including remedial education, medical examinations, psychological counseling, and social work.  Given the stigma surrounding psychological services at the time, providing assessment and counseling was especially problematic.   Intelligence testing was particularly suspect given that minority children were being routinely assigned to the Class for Children of Retarded Mental Development (often with parental permission) based on their test results. Such placement typically marked children for life and they were rarely able to return to mainstream classes.   As part of the Center's mandate, the Clarks often reevaluated the intelligence of the "retarded" children and found significant discrepancies in how minority children were being assessed.

The Clarks also continued to do groundbreaking research exploring consciousness of skin colour in children three to seven years of age.  In one classic study,  the Clarks provided children with colouring books, crayons, and a series of objects to draw.  These objects also including a picture of a boy and a girl and the children were instructed to colour the children "the way you would like them to be".    Although light-skinned children coloured the drawings of children appropriately, a significant portion of children with medium to darker brown skin coloured the pictures as either caucasian or in a bizarre colour choice such as blue or yellow.   In reporting their results, the Clarks argued that the colour choice was "an indication of emotional anxiety and conflict in terms of their own skin . . . because they wanted to be white, they pretended to be".    A similar study involving dolls with different colours of skin showed that over one-half of the study children showed a preference for the white doll and rejected the doll with a darker skin.   When asked which doll they found to be ugly or pretty, the African American children frequently showed significant tense and evasive behaviour when questioned about their own racial identity and why they preferred the white doll. 

Armed with these research findings, Kenneth Clark led a prestigious group of social scientists in preparing an expert witness brief on the detrimental effects of racial segregation.  Titled, "The Effects of Segregation", the social science brief supplemented the legal brief presented by the NAACP's legal counsel and became one of the highpoints of the three-year Brown trial.  Given the political resistance to desegregation, the Clarks and their research (particularly their "Doll Study") came under attack by conservatives.   Most of the attacks were partisan in nature and southern politicans were especially outspoken about the use of psychological theories as a substitute for the legal process.  That didn't stop them from fielding their own scientific experts however, most notably Mamie Clark's old mentor, Henry Garret.  

After leaving  Colombia in 1955  to teach at the University of Virginia,   Garrett became well-known as a strong advocate of racial segregation.  As a prominent academic whose scientific work was frequently cited by  conservatives, he became well entrenched among Virginia's segregationists and was frequently courted by the conservative elements of the state legislature.  Since desegregation was already becoming a hot issue,  Garrett helped to bolster Senator Harry Byrd's  Massive Resistance policy designed to prevent forced desegregation of schools.    As a strong hereditarian, Garrett argued that segregated schooling was necessary given that minority children were typically inferior in intelligence to white children.  He even went so far as to say that school desegregation would lead to "total demoralization and then disorganization in that order".   His condemnation of what he termed "egalitarian bias" didn't sway the juror in his favour.

Even after the Brown decision was handed down in 1954, critics condemned the use of psychological research in shaping legal policy.  One prominent legal scholar commented that the Brown decision was "caused by the testimony and opinion of scientists" and that civil rights legislation "should not rest on such flimsy foundation as some of the scientific demonstrations  in these records".  Prominent psychologists such as Bruno Bettleheim also weighed in on the issue and argued that there was no reliable evidence that racial segregation damaged the human personality.  The Clarks' research findings continued to be debated in universities and laboratories with the frequently embattled Clarks often being forced to defend their research findings against partisan critics. 

As for Henry Garrett, he continued to be active in supporting Massive Resistance legislation (which persisted well into the 1960s) as well as efforts to overturn the Brown decision.  He  became one of the prime movers for the International Association for the Advance of Ethnology and Eugenics, the Liberty Lobby, the Northern Front,  and also acted as a director of the Pioneer Fund.  Up until his death in 1973, he  continued to rail against the rejection of biological theories of intelligence and often placed the blame on "Jewish" organizations for promoting "egalitarian dogma".  The obvious racism of his views made him increasingly out of favour with other hereditarians although he is still widely cited in right-wing literature.

Both Mamie and Kenneth Clark continued with their research while Mamie Clark remained as director of the Northside Center until 1979.  By the time of her death in 1983, Mamie Clark had become a civil rights icon and, along with her husband (who died in 2005) accrued numerous honours and awards.  While basic problems with racial discrimination still persist today, Mamie and Kenneth Clark continue to be an inspiration and an example for future psychologists to follow. 

 

 

 

After Soldiers Come Home

A study published in a recent issue of Journal of Consulting and Clinical Psychology presents findings from a longitudinal study examining the impact of change in posttraumatic stress disorder (PTSD) symptoms following combat deployment on National Guard soldiers' perceived parenting and couple adjustment 1 year following return from Iraq. The study participants were 468 Army National Guard fathers from a brigade combat team (mean age = 36 years; median deployment length = 16 months; 89% European American, 5% African American, 6% Hispanic American) who completed an in-theater survey 1 month before returning home from Operation Iraqi Freedom deployment (Time 1) and again 1 year postdeployment (Time 2). The PTSD Checklist—Military Version (PCL–M; Weathers, Litz, Herman, Huska, & Keane, 1993) was gathered at both times, and 2 items assessing social support were gathered at baseline only. At Time 2, participants also completed self-report measures of parenting (Alabama Parenting Questionnaire—Short Form; Elgar, Waschbusch, Dadds, & Sigvaldason, 2007), couple adjustment (Dyadic Adjustment Scale—7; Sharpley & Rogers, 1984; Spanier, 1976), parent–child relationship quality (4 items from the Social Adjustment Scale—Self-Report; Weissman & Bothwell, 1976), alcohol use (Alcohol Use Disorders Identification Test; Babor, Higgins-Biddle, Saunders, & Monteiro, 2001), and items assessing injuries sustained while deployed. Statistical analysis of study results showed showed that increases in PTSD symptoms were associated with poorer couple adjustment and greater perceived parenting challenges at Time 2 (both at p < .001). Furthermore, PTSD symptoms predicted parenting challenges independent of their impact on couple adjustment. The study findings highlight the importance of investigating and intervening to support parenting and couple adjustment among combat-affected National Guard families

For the abstract

Haitian Cholera Epidemic Sparks Murderous Witch Hunt

Fear over the mounting casualties stemming from the fast-moving cholera episemic in Haiti has led to the deaths of at least twelve Haitians accused of using "black magic" to spread the epidemic.  Since the first case in October, the epidemic has spread to an estimated 91,000 Haitians and killed more that 2,000 to date.  Given that no cholera epidemic has occurred in Haiti in more than fifty years, natural resistance remains low and local fears concerning the unfamiliar disease has fanned tremendous anger directed against international relief efforts, the Haitian government, and local magic practices. 

In more isolated parts of Haiti, including the Grand Anse region, rumours surrounding local Vodoun practitioners and their link to the epidemic have sparked riots.  Haitian vodoun (also called voodoo) is a widely practiced religion combining elements of African and Arawakian rituals and Roman Catholicism.  As many as half of Haiti's population practice some form of Vodoun (often alongside other religions as well).  Vodoun priests (male priests are known as houngans and female priests as mambos) have plied their trade for centuries and are traditionally believed to be able to cure disease and lay curses.   Following rumours that Vodoun priests were spreading the disease using a "magic powder",  machete-wielding villagers lynched perceived offenders and burned their bodies afterward.

To combat the killings, the government in Port-au-Prince has isssued a statement stressing that "Cholera is a microbe.. The only way to protect one's self against cholera is to practice the principles of hygiene.  There is no cholera powder, nor cholera zombie,  nor cholera spirit".  The government also emphasized that Vodoun priests had no power over the disease, either in causing it or curing it.    Riots have also broken out against UN peacekeepers, who have been blamed for bringing the disease into Haiti.   While international relief organizations are on the scene, nationwide unrest stemming from the massive earthquake earlier this year which killed 230,000 people is impeding rescue efforts.

For more information.

Chronic Pain and Smoking

The prevalence of tobacco smoking among persons with recurrent pain is approximately twice that observed in the general population . Smoking has been associated with the development and exacerbation of several chronically painful conditions costing an estimated $193 billion in annual medical expenses and lost productivity.  Conversely, there is both experimental and cross-sectional evidence that pain is a potent motivator of smoking with chronic pain patients being more likely .  A recent study provided the first evidence that laboratory-induced pain could elicit increased craving and produce shorter latencies to smoke (Ditre & Brandon, 2008).   To examine interrelations between pain and smoking further, a recent study published in the Journal of Abnormal Psychology tested whether several constructs derived from social–cognitive theory influence the causal pathway between pain and increased motivation to smoke. A sample of 132 smokers were randomly assigned to 1 of 4 conditions in a 2 × 2 between-subjects experimental design with dependent measures including self-reported urge to smoke and observed smoking behavior.  Results indicated that manipulations designed to (a) challenge smoking-related outcome expectancies for pain reduction and (b) enhance pain-related coping produced decreased urge ratings and increased latencies to smoke, relative to controls. An unexpected interaction effect revealed that although each manipulation was sufficient to reduce smoking urges, the combination was neither additive nor synergistic. These findings were integrated with existing literature to conceptualize and depict a causal pathway between pain and motivation to smoke as moderated by smoking-related outcome expectancies and mediated by the use of pain coping behaviors.

For the abstract.

What Is Psychosis Risk Syndrome?

While the age of onset for schizophrenia and many other major mental illnesses typically falls into the early twenties, clinicians have long noted the existence of early indicators which act as a warning that a first psychotic episode may be  imminent.  Usually referred to as prodromal symptoms (prodrome is a clinical medical term referring to the early symptoms or signs that precede the full-blown illness), research literature has identified behavioural shifts that might indicate impending psychosis (although such symptoms tend only to be recognized in retrospect).  Prodromal signs in patients with known psychosis might also signal an impending relapse and mental health workers are trained to recognize the warning signs so that proper intervention may occur.   Such symptoms may either be recognized by the patient directly, by clinicians,  or by family members.  These symptoms might include changes in mood, increasing disinhibition, or bizarre ideas (such as paranoid claims or unusual beliefs).   Since delayed treatment for a first psychotic episode can often worsen the outcome, there is a very real need to act on prodromal symptoms as soon as possible.  Unfortunately, given that the presence of prodromal signs do not invariably result in psychosis, acting prematurely can often do more harm than good. 

Scheduled for publication in May 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) represents the latest attempt at classifying the vast range of different ways in which mental illness can be manifested.   Currently in the consultation phase, the DSM-V contains a proposed psychosis risk syndrome diagnosis which has attracted controversy.  Also referred to as Attenuated Psychotic Symptoms Syndrome, the suggested diagnostic criteria are:

All six of the following:

a) Characteristic symptoms: at least one of the following in attenuated form with intact reality testing, but of sufficient severity and/or frequency that it is not discounted or ignored

• (i)delusions,
• (ii) hallucinations
• (iii)disorganized speech 

b) Frequency/Currency: symptoms meeting criterion A must be present in the past month and occur at an average frequency of at least once per week in past month

c) Progression: symptoms meeting criterion A must have begun in or significantly worsened in the past year;

d) Distress/Disability/Treatment Seeking:  symptoms meeting criterion A are sufficiently distressing and disabling to the patient and/or parent/guardian to lead them to seek help,

e) Symptoms meeting criterion A are not better explained by any DSM-5 diagnosis, including substance-related disorder.

f)  Clinical criteria for any DSM-V psychotic disorder have never been met

Mental health professionals testing for the diagnosis are advised to assess each dimension on a four-point scale ranging from 0 (Not present) to 4 (Present and severe).   Hallucinations and delusions are assessed separately and a separate category for cognitive impairment has also been proposed.   In proposing the new diagnosis, the DSM-5 work group has argued that early signs and symptoms of schizophrenia can be identified long before the first psychotic episode and some researchers have even suggested that schizophrenia risk can be predicted in infancy.   While acknowledging the potential impact of stigma and negative predictive ability, the proposed diagnosis is currently being evaluated in field trials to determine whether it should be included in the DSM-V as part of the main manual or in the Appendix as worthy of further research.  It has also been the subject of considerable attention the clinical literature (both pro  and con) as well as the mainstream media. 

In a recent article in Harper's Magazine, author Rachel Aviv discussed many of the real-life implications of psychosis risk syndrome.    The article (of which the author very kindly provided a reprint) provides interviews with several young adults who were patients at several of the sixty clinics in the United States providing treatment for early psychotic symptoms.  Given that these patients are still in the very early stages of their illness, the question of whether the symptoms would procede to full-blown psychosis is very real.   She also presents some of the findings of the North American Prodromal Longitudinal Study (NAPLS).   Made up of eight research centres based in universities and hospital clinics across the U.S. and Canada, the NAPLS consortium was awarded a five-year grant by the National Institute of Mental Health to undertake a prospective, longitudinal study of 720 prodromal patients and 240 matched healthy controls for the purpose of establishing and refining prediction algorithms intended to identify those at greatest risk for developing schizophrenia.  While initial studies showed risk of onset to be only 35% using conventional clinical protocols for assessing psychosis risk, the NAPLS algorithms showed significantly improved prediction ability (but moderate sensitivity).   The ongoing NAPLS research project will be incorporating neuroimaging, genomic, electrophysiological, hormonal, and psychosocial factors to create a data-set twenty times larger than any other study previously undertaken. 

The proposed psychosis risk syndrome diagnosis for the DSM-V is largely based on the preliminary findings of the NAPLS although fundamental questions remain concerning the ethical consequences of false positives as well as how soon biomedical interventions should begin in cases of prodromal psychosis.    If prodromal patients never progress to full-blown psychosis , would they be able to live normal lives without the stigma often attached to mental illness in most societies?  These are concerns which are only beginning to be addressed.