The Agenda with Steve Paikin (Audio) - Why Are Psychotic Disorders in Young People on the Rise?

Episode Date: March 13, 2026

The Rundown examines the rise of psychotic disorders among young people in Ontario. What's driving this increase, and how does a diagnosis affect those who receive it? Then, how exploring historical theories of dreams can help us better understand the complexity of the human brain.See omnystudio.com/listener for privacy information.

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Like somehow, while you were sleeping, your brain figured it out. No conscious thought required. So how does that happen? We look at what science has to say about the stuff that dreams are made of. We still don't have all the answers. No surprise, because the brain is incredibly complicated. And even now, much of it remains a mystery to scientists and philosophers alike. But researchers are putting together some pretty interesting pieces of the puzzle and raising new sets of questions.

For example, a new Ontario-based study finds that rates of new diagnoses of psychotic disorders, including schizophrenia, increased by 60% in people aged 14 to 20 over the past few decades. We break down what the data shows and what it may mean. Welcome to the Rundas. A new study published in the Canadian Medical Association Journal says that between 1997 and 2023, the annual incidence of psychotic disorders increased by 60% among people aged 14 to 20. I sat down with one of the co-authors to understand what the numbers are telling us and the questions they leave behind. Dr. Paul Kodiak is a psychiatrist and scientist at the Center for Addiction and Mental Health in Toronto

and a senior scientist and lead of the Mental Health and Addictions Research Program at I-C-E-S. And he joins us in studio. How are you, sir? Great. Thanks for having me. All right, your study measured the incidence of psychotic disorders across different groups in Ontario. When you stepped back and looked at the findings, what surprised you the most? Well, I think the first thing that surprised me, and I should say at the beginning, that I was a co-author on this study, It was led by a colleague of mine at a University of Ottawa.

Dr. Daniel Myron did a great job in this project. When we looked at the findings, there are a couple things that struck out. One is that the incidence, which means the rate of newly diagnosed individuals, is increasing over time. It is happening in younger individuals over time. And then the third piece is the way that the diagnoses are breaking out. So there are different types of diagnoses that are part of what we call psychotic disorders. And that's a bit of a nuanced aspect of the study, but that was a third piece that was kind of interesting to us.

All right. Well, let's pick up on that. When you say psychotic disorders, what do we mean? We have schizophrenia in one realm, an umbrella term, perhaps, and then we have schizophrenia, and then we have psychosis. help us understand sort of the terms there. Yeah, so there's schizophrenia and schizoaffective disorders, and for people to be diagnosed with those conditions, they need to meet certain criteria.

And that, the incident rate for those diagnoses have increased a little bit, but not that much. The one that's increased more so is called psychosis, not otherwise specified. And this is a diagnosis that clinicians like myself use when somebody is clearly presenting with prominent psychotic symptoms, like a deviation from reality. Sorry, hallucinations. Delusions. Exactly. And but but they, but there are other issues that prevent us from saying it is clearly schizophrenia and schizoaffective disorders.

So we know that the person's psychotic, but there could be other factors that that may ultimately. be contributing to it, like it could be related to substance use, it could be related to medical conditions, et cetera, et cetera. So it's kind of like a hedge diagnosis. It is definitely a psychotic disorder. And most individuals with this diagnosis do over time evolve to developing a diagnosis schizophrenia. It suggests the level of uncertainty that it is truly schizophrenia at the time of first diagnosis.

I don't want to simplify it, but fair to say, like you may. the specific set of symptoms, one of them is it's chronic with schizophrenia. That is long term. That's about usually six months or more. Correct. Okay. All right, I want to look at a graph from this study. This graph shows the incidence rate ratios for schizophrenia spectrum disorder, which is in the dark blue color. Psychosis, not otherwise specified in green, and psychotic disorders, which include both schizophrenia and psychosis in black. Now, for each cohort studied, this is comparing to the 1975-1979 cohort. For psychotic disorders, the black line,

there is a gradual increase in the rate of diagnosis, starting with those born in the 1985-89 cohort. When researchers separated the data, it showed that the rate of schizophrenia goes up slightly, but then starts to go down, but the rate of psychosis increases kind of like a ski hill. What is this telling us? Yes, so if we return to the different,

between psychosis not otherwise specified and something that is like truly a schizophrenia spectrum disorder, it is the market increase in the sort of the slightly uncertain category, the psychosis not otherwise specified, which means that at the time of first diagnosis, there is less certainty that this is truly schizophrenia,

which means that there's complexity in the diagnosis over time, that is increasing the most. A lot of headlines in terms of what is causing it. This study was not looking at what was causing this, but help us understand what are some links that have been sort of made. Yeah. So I think the first important point is that this study was very well designed to characterize changes in rates over time.

There's nothing about this particular study that helps us understand. why we're observing what we're observing. So when I think about the links, it's really like extrapolating to evidence beyond this study. But I would say what we are observing generally amongst young people, and these are a 16 to 35-year-old individuals typically, what we're observing amongst young people

is they are far less stigmatized than previous generations and much more inclined to seek help. So that may partly explain why we're seeing more and younger. The other factor is that over time, there has been more robust implementation of early psychosis intervention program, provincially. Okay. So anytime you put more services into a province, that there's a tendency to pull in more cases. And then the third piece that actually is the cause for concern is the fact that the rise in the less certain diagnosis and not otherwise specified is occurring dramatically at a time of cannabis legalization.

And what comes with cannabis legalization is the young people are exposed with high potency cannabis cannabis, which evidence outside of this study suggests does pose a serious risk for the onset of psychosis. What does cannabis high potency or not, these are young brains that we're talking about. We're talking, you know, when they're still developing up until about the age of 25. But what does it do to the brain? Yeah, so there's, so it's not entirely clear, but it does seem to, like, there's a, there's a, there's a, aggregation of evidence that suggests that there's something about the THC chemical and cannabis that binds with certain receptors in the brain that causes a biological inclination to become

psychotic. So the way I think about it, and there are people who are better experts than me on this, is I think if you are vulnerable to developing a psychotic disorder, exposure to high-potency cannabis may increase your likelihood to develop a psychotic disorder. order. Okay. Is there a difference between men and women? There's been a baseline difference in men and women in the onset of schizophrenia. So men develop psychosis at a younger age. They tend to be more disabled as a result of the condition. The ratio of men to women is a little higher in men. And of course, as it relates to the cannabis risk factor, and actually to the service utilization,

Young men are notoriously difficult to engage in health care, and they are much more likely to consume substances than women. We talked about legalization, of course, 2018. Looking at this data, and of course this is just the beginning here, is that the right call? It's an important question. Policy is inherently a compromise, and I think that the legalization issue in 2018 responded to a couple of important issues. One is that, I mean, if you walk around Toronto, there's clearly a public interest in having ready access to marijuana recreationally. I mean, that is just what people want. And so policy follows what people want typically. I also think, and this is a really

important piece, is that when cannabis was illegal, the consequences of it being illegal, incarceration for possession, did not happen equitably. And that we knew that more marginalized individuals were more likely to be incarcerated and have all the negative consequences of having a criminal record, et cetera, as a result of that. So that was a very good, legitimate reason to enact the policy. But now, as more evidence emerges, like, this is what we want to be able to do, right, and monitor unintended consequences of policy.

So now what do we do? And to me, like, tobacco is probably a better example than alcohol. Tobacco is a legal substance, but it's pretty highly regulated and highly taxed. So, you know, I think there are policy solutions to find that compromise or balance between, you know, maintaining the benefits for which the policy was first enacted at the same time address some of the risks that we're learning about. All right. receiving this kind of diagnosis can be frightening for many. Could you explain how this diagnosis is challenging for the individual or for those who are in their lives as well?

This is, you know, my clinical work is in the CAMH emergency department, and this is one of those ones where you really feel for the individual. So how it manifests, it typically, it is a, often a slowly evolving sort of deviation from reality and also often a slowly evolving social withdrawal. So a young man in high school, like totally social, engaged in everything, starts to withdraw from stuff, then starts like avoiding school, reluctant to avoid school, family starts noticing that he might be sort of talking to himself, laughing inappropriately at times. So that's kind of how it manifests. And it's incredibly important that individuals have access to care early

because we know that the longer an individual goes untreated, the worst the prognosis is. Like if we can get people into care early, we can really change the trajectory of the young person's life. I think I know the answer to this, but are there enough supports in place for those seeking? I would say that throughout our province, we know that we don't have enough services for individuals struggling with mental health generally.

In this case, we do have, in comparison to other areas of our mental health system, we do have a robust system of early psychosis intervention programs that currently exist. But evidence that has come out of my research team suggests that even though this provincial network exists, not everybody with the disorder can or does access them. And some of that has to do with inadequacy of resources. Some of it has to do with awareness. And so, for example, if you're diagnosed by a psychiatrist or diagnosed in a hospital setting, you're much more likely to be referred to one of these programs.

excuse me, then, if you were managed in primary care. And that's probably just an awareness situation. And that's a big problem because what we know about the consequences, in addition to, like, longer periods of no treatment, this is a deadly illness. That, you know, people who are diagnosed in a hospital, these are 16 to 35-year-olds. One in 25 die within five years.

if you're diagnosed an outpatient setting 1 in 40, nobody should be dying between the ages of 16 and 35. How do they die? The most common cause is suicide. Okay. Yeah. The suicide rate is incredibly high, and it just makes sense,

because these are young people who have a sense of who they are and what they're going to be doing in their life, and their whole identity gets rocked by this diagnosis. All right, doctor, we're going to have to leave it there, but I really appreciate your insights. Thank you for this. And of course, with this, there will be more things to come out of this in terms of research and studies and policies. So we look forward to that.

And thank you so much. Thanks very much for having me. When Karen Van Campin was a child, she hung out at her father's lab, one of the first independent sleep labs in North America. Now, the health and science journalist has turned her lifelong interest in sleep, dreams, and everything in between into a new book called The Brain Never Sleeps, Why We Dream and What It Means for Our Health. Karen Van Campen is a health and science journalist. How are you doing, Karen? I'm well. How are you? I'm doing well. Let's talk. Dreams are quite complex. There's emotions, there's visual components to help us understand what parts of the brain are affiliated with dreams.

dreaming? So different parts of the brain are active at different times in the sleep cycle. Um, one part of the brain that's active during dreaming is the emotional center of your brain. So, um, the parts of the brain that help process emotions that, um, are involved in our feelings, uh, the prefrontal cortex, uh, during REM sleep, it's less active than when we're awake. And that's the part of the brain that really deals with making decisions, thinking rationally, and that's less active during REM. All right. You mentioned REM and you mentioned cycles.

So REM to simplify rapid eye movement. Yes. And then there is non-rapid eye movement. You mentioned which cycles we dream in. How do we know? There's eye movement. That's very clear in when we talk about. But how do we know that's where we dream?

So we dream through non-REM and REM. So non-REM sleep is stages 1 through 3, stages 1. stages one, two, and three is non-REM sleep. And REM sleep is stage four. So we actually dream all through the sleep cycle, all through the night. So that's... Where are the best, most vivid dreams? REM sleep.

So it's typically our most intense, vivid, emotional dreams happen during REM. And we get to our first REM. We go through four or five stages of the sleep cycle a night. And so we get, it's about 90 minutes into the sleep cycle that we have our first period of REM. Okay. Reading your book, you have, I would say, quite an unusual childhood in terms of what you were, what you experienced. What drew you to understand more about sleep and dreams? And I know your father had a lot to do with that. So my dad's a sleep doctor, so I was always immersed in this world of sleep. And I sort of look at it as sleep was kind of like this

gateway to the world of dreams. And so I was always, you know, always thinking about sleep and trying to get enough sleep, and sleep is a really big part of growing up my childhood. And then a few years ago, I read this scientific study that said, we're as dream deprived as we are sleep deprived. And it made me think, you know, why do dreams matter on their own? It's, you know, not just sleep. Sleep is its own industry, and we're very focused on sleep. But what about dreams? And then it got me, it turned me on to the science of dreaming. As you mentioned, and what we've talked about in terms of the brain, we have come a long way in terms of understanding the brain. Yes.

Do we better understand dreams? I know this is a question of why do we dream has been asked for decades. Yes. But do we have a better understanding of that? So there's many possibilities of why we dream. So one idea is that we dream to help dream sleep and dreams help consolidate memories. So let's say we've learned something new during the day or we've had a new experience, it's thought that during sleep and during dreams, it helps to strengthen these

memories. So that's one thing, is memory consolidation. So a cabinet of dreams that you can put in and... Yes, exactly. So, and then it's really neat. So one idea is called this, it's called the next up model of dreaming. And I found this fascinating because I've always wondered, you know, why do I suddenly dream of something from my childhood or years ago? Why do I, do I choose to say, of it tonight? What is it? And this idea is that in order to strengthen memories, say, recent experiences, recent memories, you associate it with memories from your catalog of memories that are already stored in your brain. So it's finding possibilities through these connections, these unique and, yeah, unique connections through these associations.

Another theory is sort of viewing dreams as sort of a night therapy. Walk me through that. That sounds interesting. It's so interesting. So Matthew Walker, so it's Dreams as Overnight Therapy. And the whole idea about Dreams is overnight therapy and other dream researchers have also studied this is that it helps to process our emotions. So it helps come to terms with, say, difficult emotions. Rosalind Cartwright, she was known as the Queen of Dreams. And she did these studies on people who were going through divorce.

and she found out if you dream, you have these unsettling dreams about your divorce, you actually, the subjects tended to cope better a year later. So that is also. So it helps to process the emotions, but keep the details of the memory. There's also this thinking of our dreams. Some people may look at them as two separate compartments,

when we're awake and we're falling asleep. But when we wake up sometimes, we might have solved some of the issues that we dealt with. Help us understand perhaps how dreams kind of help us when we wake up in our real world. So it's thought that when we're falling asleep, we sort of tag certain ideas to revisit later in the night.

So let's say you're trying to, you know, you're noodling around, you're thinking about a problem you're trying to solve. You might be thinking about it as you're falling asleep. So during sleep onset, it's this really unique time. It's almost like a dreamy brainstorming session. I'm going to say it's like a to-do list. It's another to-do list.

Yeah, exactly. So you can even guide your dream thoughts. That's about dream engineering. Okay. And so let's say you want to work on a problem. You want to solve a problem or you want to think about a new creative idea. When you're falling asleep, you can think about this idea, think about this problem that you want to work on. And then oftentimes it will help guide your dreams.

So those thoughts that you're thinking about. And dream engineering uses technology to, um, help you guide and shape your dreams. So I did this dream experiment, and it was really fun. And so basically, Adam Har, he's a dream researcher, and he helped me set it up this sort of ad hoc dream experiment at home. And so as I was just falling asleep in sleep onset, the first few minutes of sleep, a recording,

I did a recording before, and then the recording played, and it said, it was my voice, and it said, remember to think of a tree. Ah. And then so then that would help guide my dreams. And what did you dream that? I dreamt about all these different trees.

First, it was very concrete. Okay. And I was dreaming of, there was this willow tree in front of this cabin where our family used to have this cabin. And then it started to get, the farther I went into sleep onset, it started getting more creative and not as concrete and not as logical. Okay. And then I thought of this time. that my husband and I got lost in these woods.

And then the trees became waves. And so it got very abstract almost. Okay. Speaking of abstract, let's talk about lucid dreams. I'm sure there are many listeners who have probably had a dream where they're running. And then all of a sudden they're like, hold on, I am dreaming. I know I'm dreaming and probably stop. Explain to us about lucid dreams, what can you tell us about them?

Why do we have control? So lucid dreaming is when it starts with to be aware that you're in a dream as the dream is happening. So it's to have that awareness. And then once you gain the awareness, it's to develop that skill to actually learn that your dream is a, it's a creation of your imagination. So you actually can be in control. So then you start to control your dream characters or maybe the plot. You could choose, you know, what to do, what you've always wanted to do. Some people want to try and fly.

I talked to a dream researcher and he told me there's an artist and he imagines an art gallery. And he opens the door and goes into this art gallery and there's all these beautiful paintings. And they're a creation of his own imagination and mind. So then he wakes up and sketches out what he was dreaming. All right. I feel like there's a lot of power to harness here. If we can really sort of figure it out. On the flip side, there's something that you talk about in your book.

book called Dream Advertising. Yes. Help us understand what that is. So it was brought up a few years ago, and so basically we are more, we are vulnerable when we're sleeping, and so the question was brought up, let's say if we have a speaker in our, in our bedroom, and it could, you know, if we're susceptible to ideas and thoughts, could it then, could we be influenced, say, if a company wanted to, you know, say, if a company wanted to, you know, they pushed their product while we were sleeping.

Yeah, so that's kind of what it is. So, you know, the, is it probable? Is it possible? These are sort of, you know, things where technically, if we're susceptible to suggestion at certain times of the sleep cycle, but is it really probable that this will change our, say, buying and consumer habits? What does that tell us about the power of dreams in our lives?

I think that dreams are so powerful. I mean, it's, it makes me think, you know, know, we spend a third of our lives asleep and a large portion of that time dreaming. And there's this whole, this mental life that we have there that we can tap into to try and, you know, guide our dreams for creativity, to solve problems. And then in the morning, use our dreams to better understand, say, our preoccupations or our concerns what's sort of weighing on our minds. During the production of this book, you have delved into a number of studies.

I am curious, what's one that kind of left you? sitting back and being like, that is like amazing to think how our brain works when it comes to dreams? So the work that I was so, so dream engineering for sure that I talked about. And then also anesthesia dreams. Okay. So it's a group of researchers at Stanford. And they've discovered that if you keep a patient at a certain brain state just under the

level of consciousness, they come to this. calm, relaxed state. And it's wonderful because you can revisit potentially difficult and even traumatic experiences and events, but having this calm state. So you're able to revisit them and then almost create new memories of them. And so I spoke with people who had these experiences as well, and they said they were life-altering, transforming. So it's unbelievable, actually. The potential is... Potential, yeah. There's so much there. I can't imagine what your bedside table looks like,

but I imagine there's probably a book and a pen there. Yes. I will admit, before this interview this weekend, I was trying to remember my dreams. Right. Because lots of people, when they share dreams, they want some interpretation of the symbols. Yes.

How do we take full advantage of our dreams? So I always think we're the best interpreter of our own dreams. So it's how we want to tap into them, delve into them, look at them differently. You know, we know if, let's say there's a certain theme or even a person keeps showing up. The way I look at it is it's like our dreams are saying, you know, pay more attention to this idea or maybe this person. That's something that you can do. I did a dream salon.

I did read about this. Oh, okay. So it was so interesting. I've never shared a dream before. And so it was with a group of friends, Andrew. researchers, and it was so interesting because I shared a dream. And the perspectives that other people had on, so you, you share your dream and then different people say, you know, if it was my dream, I would maybe think about this. And it totally changed my perspective on my dreams. And then,

you know, you can, you can look at it from other people's perspectives and, and see what works for you. Very fascinating stuff. This is a really exciting read. Lots of potential as we talked about. Karen, and thank you so much for this. Really appreciate it. Thank you. It was great chatting. I'm Jan. Thanks for watching The Rundown.

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