Familiarity for Serious Mental Illness in Help-Seeking Adolescents at Clinical High Risk of Psychosis.

Michele Poletti,Federica Paterlini,Simona Pupo,Silvia Azzali,Luigi Rocco Chiri,Ilaria Scazza,Andrea Raballo,Sara Garlassi,Lorenzo Pelizza

doi:10.3389/fpsyt.2020.552282

Abstract

Aim: Ultrahigh-risk (UHR) individuals have an increased vulnerability to psychosis because of accumulating environmental and/or genetic risk factors. Although original research examined established risk factors for psychosis in the UHR state, these findings are scarce and often contradictory. The aims of this study were (a) to investigate the prevalence of severe mental illness (SMI) in family members of distinct subgroups of adolescents identified through the UHR criteria [i.e., non-UHR vs. UHR vs. first-episode psychosis (FEP)] and (b) to examine any relevant associations of family vulnerability and genetic risk and functioning deterioration (GRFD) syndrome with clinical and psychopathological characteristics in the UHR group.Methods: Adolescents (n = 147) completed an ad hoc sociodemographic/clinical schedule and the Comprehensive Assessment of At-Risk Mental States to investigate the clinical status.Results: More than 60% UHR patients had a family history of SMI, and approximately a third of them had at least a first-degree relative with psychosis or other SMI. A GRFD syndrome was detected in ~35% of UHR adolescents. GRFD adolescents showed baseline high levels of positive symptoms (especially non-bizarre ideas) and emotional disturbances (specifically, observed inappropriate affect).Conclusions: Our results confirm the importance of genetic and/or within-family risk factors in UHR adolescents, suggesting the crucial need of their early detection, also within the network of general practitioners, general hospitals, and the other community agencies (e.g., social services and school).

Highlights

In the last three decades, the early intervention in psychosis (EIP) paradigm has achieved increased consideration attention in the scientific community, generating focused programs of care within the mental health care network of different countries [1]
As psychosocial dysfunction represents a common prodromal sign in ultrahigh risk (UHR) mental states, which exposes these young help-seeking individuals to social stigma and longterm interpersonal marginalization, reducing employment and economic opportunities [16], it is absolutely crucial to implement effective models of early detection of psychosis vulnerability as soon as possible within the mental health service network, especially because this “functional critical period” may be susceptible to change if effective interventions are provided [5]. Starting from this background, the first aim of the current study was to investigate the prevalence of severe mental illness (SMI) in family members of UHR adolescents compared to similar age group of help-seeking peers with first-episode psychosis (FEP) or not meeting both UHR and FEP criteria [11]
No statistically significant intergroup-differences were found in terms of family load for SMI, more than 60% of our UHR+ and FEP adolescents showed a general family history of SMI, and approximately a third of them had at least a first-degree relative with psychosis or other SMI

Summary

Introduction

In the last three decades, the early intervention in psychosis (EIP) paradigm has achieved increased consideration attention in the scientific community, generating focused programs of care within the mental health care network of different countries [1]. Vulnerability in UHR Adolescents health (e.g., treatment dropout, inpatient care, symptom severity), as well as in socioeconomic costs related to unemployment, long-term intervention, and poor outcomes of illness [2,3,4]. The most validated model to explain the etiology of psychosis is based on environmental and genetic risk factors and their interaction (in various modalities and at various levels), likely involving epigenetic mechanisms [6, 7]. The evidence that many subjects who are at ultrahigh risk (UHR) of psychosis do not develop a full-blown psychotic episode seems to confirm this hypothesis, suggesting a complex interplay among genetic, neurodevelopmental, neuropsychological, sociocultural, and environmental factors in psychoses [6]. The delivery of specialized, evidencebased treatments as early as possible has become one of the current priorities for professionals involved in mental health care service network [9, 10]

Objectives

Results

Discussion

Conclusion