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November 28, 2005
Psychiatrist examines schizophrenia in pair of studies

By Alicia Sands Lurry

Schizophrenia is a serious mental illness, and research shows that the longer patients and their families wait to seek treatment the more debilitating the disease can become. An Emory researcher at Grady Hospital is involved in two studies trying to identify risk indicators for schizophrenia, as well as explore why individuals and families often delay treatment after onset of disease symptoms.

Michael Compton, assistant professor of psychiatry and behavioral sciences, is leading one project in the Grady Health System to study how five traits may be risk indicators for schizophrenia and examine possible correlations with asymptomatic family members.

The Associations among Risk Indicators in Schizophrenia (ARIS) Project, funded by a $45,000 grant from the American Psychiatric Institute for Research and Education, aims to determine whether risk markers cluster within individuals with schizophrenia, within first-degree family members, and between patients and their family members.

Compton recently received a $25,000 Emory Medical Care Foundation grant to extend the project. ARIS-II will add a component to assess detailed family history and study “familial loading” (one’s presumed level of genetic tendency toward developing the illness) in the context of the five risk markers. The researchers also will add a genetic component by examining a specific gene that is involved in cognitive functioning.

“We know of about eight to 10 risk markers for schizophrenia,” said Compton, the study’s principal investigator. “These risk markers are also present in first-degree family members who don’t have the disease, and while each marker has been studied individually, they have never really been studied all together in the same patients and family members.”

The five markers include subtle fingerprint abnormalities, impairments in smell identification, minor physical anomalies (specific traits of the head, face, hands and feet), neurological “soft signs” (such as mild coordination problems), and impaired verbal memory.

Schizophrenia affects approximately 1 percent of the population over the course of a lifetime. It is associated with a variety of symptoms, including “positive” ones such as auditory hallucinations and delusions, “negative” ones such as social isolation and diminished drive, and subtle cognitive symptoms including disruptions in attention and memory.

Recently Compton completed data collection for the first phase of the ARIS project and is now beginning data analysis. Forty-one patients, 27 first-degree relatives and 38 normal comparison controls were enrolled in the project.

“The whole point of this type of research is that maybe someday we can better understand who is at greatest risk for developing the disease,” Compton said. “If we know who is at highest risk, then maybe we can do something down the road to actually prevent, or at least delay, the onset of the disease.”

What happens following onset is the subject of another Compton study. The ACES project (Atlanta Cohort on the Early course of Schizophrenia) is funded by a career development grant from the National Institute of Mental Health and seeks to determine why people wait to get help once the symptoms of schizophrenia appear.

“Research has shown fairly consistently that, in the case of early schizophrenia, the longer you wait before you seek treatment, the worse your outcomes are over the first few years of the illness,” Compton said. “Some patients may delay treatment for only a couple of weeks; others may delay for several years.”

As part of the project, Compton and other researchers interview patients between the ages of 18 and 40 who present at Grady and DeKalb Crisis Center with a schizophrenia-related illness. They also assess patients’ family members; relatives typically bring patients to the hospital rather than the patients themselves, and the relatives therefore provide a window into the patients’ early disease course.

Researchers examine family strengths and coping mechanisms; beliefs about what causes schizophrenia; general level of knowledge about the disease; and health insurance status to determine if these factors are correlated with how long patients and their families wait to seek treatment.

So far, 36 patients have been assessed with a first episode of a schizophrenia-spectrum disorder. Researchers are now implementing a qualitative component in which they will interview family members to further study determinants of the duration of treated psychosis or early treatment delay.

“If treatment delay is related to lack of knowledge about the symptoms and perceived stigma in the community, for example, then we need to develop public education campaigns about the early signs of schizophrenia in order to raise knowledge and decrease stigma,” Compton said. “Someday we might see a better outcome for the disease because patients are coming into treatment earlier.”

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