Early detection and intervention of psychosis. A review

Abstract

The vulnerability and hybrid models for the onset of psychosis are presented. Familial liability, perinatal and developmental factors, and decreased cognitive performance associate with psychosis in adolescence and young adulthood. Genetic predisposition connected with behavioural deviances and/or mental symptoms associate with psychotic development so strongly that monitoring and intervention are indicated. Especially, in families where one or both parents or other family members are severely mentally ill, early family-centred assessments and interventions is needed. Together with familial psychosis, deficits in adolescent and young adult social development indicate thorough assessment, intensive monitoring and often also preventive interventions. During the prodromal phase of psychosis, patients often display unspecific symptoms, such as anxiety and depression, personality disorders, abuse of alcohol or drugs. Social decline, possibly associated with neurocognitive deficits, frequently occurs in the prodromal phase or in the early course of schizophrenia. Among help-seeking patients, occurrence of the Basic Symptoms represent the early initial prodromal state, while the late initial prodome state includes attenuated psychotic symptoms, brief limited intermittent psychotic symptoms, and a first degree relative with psychotic disorder, or a schizotypal personality disorder, together with decrease global functioning. These patients suffer also from other mental symptoms and functional decline, and are clearly in need of psychiatric assessment and treatment. Intervention trials have shown that patients suffering from prodromal syndromes can be successfully treated, and onset of psychosis prevented or delayed. However, more large-scale studies and clinical case descriptions of treatment of patients with sub-threshold psychotic symptoms are needed.