Advances in clinical staging, early intervention, and the prevention of psychosis.

Tina Gupta,Vijay A Mittal

doi:10.12688/f1000research.20346.1

Abstract

The development of effective intervention and prevention strategies among individuals with psychosis risk syndromes may help to reduce symptomatology and conversion to a psychotic disorder. Although strides have been made in this area, more work is needed, particularly given the setbacks that remain (such as heterogeneity among this group). There has been a shift with the introduction of clinical staging models toward expanding current intervention and prevention efforts to a more developmental and transdiagnostic approach. With this, this article seeks to review treatments both recently and currently discussed in the staging literature, introduce advances in psychosis risk syndrome treatments that may be beneficial to consider in clinical staging heuristics, and pinpoint other promising options.

Highlights

First published: 29 Nov 2019, 8(F1000 Faculty Rev):2027. Psychotic disorders such as schizophrenia typically emerge early in adulthood, during a time when adolescents and young adults are beginning to gain a sense of independence and develop skills intended to set them up for life[1]
In the past decade, there has been a push to intervene prior to psychosis, before symptoms impacting motivation or pleasure and factors such as illicit drug dependence or impacted cognition get in the way of optimal intervention efficacy
There is evidence that individuals with mental health challenges do own smartphones[98], and the implementation of smartphone apps has been found to be possible in early psychosis to monitor symptoms, mood, and sleep difficulties in conjunction with clinical care[99,100]

Summary

Introduction

Psychotic disorders such as schizophrenia typically emerge early in adulthood, during a time when adolescents and young adults are beginning to gain a sense of independence and develop skills intended to set them up for life[1]. There is evidence that individuals with mental health challenges do own smartphones[98], and the implementation of smartphone apps has been found to be possible in early psychosis to monitor symptoms, mood, and sleep difficulties in conjunction with clinical care (clinicians can review these ratings in treatment sessions and help develop more targeted weekly interventions)[99,100] The benefit of these tools is that they can provide real-time intervention, and given the rates at which individuals own smartphones and enjoy using them, the likelihood of treatment adherence may be high[101]; more work in this area is needed before definitive conclusions can be made. This study highlighted the potential to use NCP as a safe analogue population, which may be useful in the development of newer treatment interventions for psychosis risk syndrome groups Work in this area is still growing, tDCS may be a tool that could be applied when early signs of symptom progression and cognitive decline are observed and begin to interfere with daily life. There is increasing research examining protective factors such as family environment[34], psychosocial interventions[141] and resiliency[142], research into the efficacy of the implementation of treatment approaches to enhance the role of these protective factors is imperative

McGlashan TH

18. Schultze-Lutter F

52. Thompson C

Findings

96. Insel TR: Digital Phenotyping