UC HEALTH LINE: Young Adults Most Common Age Group to Experience 1st Onset of Psychosis

CINCINNATI—All eyes were on suspect James Holmes Monday as he made his first court appearance in connection with the shooting deaths of 12 people and wounding of 58 in a crowded movie theater in Aurora, Colo.

While media speculation focused on Holmes’ state of mind at the time of the shootings, mental health professionals and organizations—including the National Alliance on Mental Illness (NAMI), in a message from national executive director Mike Fitzpatrick—cautioned that it’s impossible at this point to know the motives involved.

Still, the horrific incident focused attention on the risk of violence among individuals with mental illness, a risk that the U.S. surgeon general has said increases to some degree in the case of substance abuse or psychosis, which can manifest itself in a psychotic "break with reality” through paranoia, hallucinations or delusions.

According to NAMI, young adults in their 20s (Holmes is 24) are the most common age group to experience the first onset of psychosis. It’s a time filled with challenges, including moving away from home, establishing an identity and developing new relationships.

From a scientific standpoint, says Henry Nasrallah, MD, a professor in the University of Cincinnati (UC) Department of Psychiatry and Behavioral Neuroscience and UC Health psychiatrist, crucial changes in the brain are occurring around age 20-24.

"The myelination process in the brain—enveloping the neuronal pathways with white matter—is necessary to make a brain region functional,” Nasrallah says, "and the very last areas of the brain to be myelinated, the prefrontal and medial temporal circuits (hippocampus), are the same regions that have been implicated in producing delusional thinking and cognitive distortion.

"These regions may be abnormal from childhood, but remain dormant and manifest the psychopathology only after they are myelinated in late adolescence or early adulthood.”

Psychotic disorders, such as schizophrenia and bipolar disorder, are treatable, NAMI’s Fitzpatrick stresses, adding, "Many people recover from a first episode and never experience another one.” The first step, he says, is recognizing onset of the illness and getting treatment. (Nasrallah notes that delay in treating psychosis has been repeatedly shown to worsen the course and outcome of the illness.)

Fitzpatrick and Nasrallah list the following early warning signs, particularly in the year leading up to the "break with reality”:

• Worrisome drop in school or job performance.

• New trouble thinking clearly or concentrating.

• Suspiciousness or uneasiness with others.

• Decline in self-care or personal hygiene.

• Spending a lot more time alone than usual, including increased sensitivity to sights or sounds.

• Bizarre behavior.

Fitzpatrick, noting that the likelihood of violence from people with mental illness is low, adds, "Regardless of whether or not violence is a concern and regardless of what the case may turn out to be in the Aurora tragedy, the first step is to recognize warning signs of illness and to reach out to a person who may be in trouble.

"Help them get help.”