Abstract
In children and adolescents, schizophrenia is one of the ten main causes of disability-adjusted life years. The identification of people at Clinical High Risk of developing Psychosis (CHR-P) is one of the most promising strategies to improve outcomes. However, in children and adolescents research on the CHR-P state is still in its infancy and the clinical validity of at-risk criteria appears understudied in this population. Furthermore, only few studies have evaluated the psychopathological, neuropsychological, neuroimaging characteristics and, especially, long-term outcomes of adolescents at high risk. We present here the protocol of an innovative longitudinal cohort study of adolescents aged 12-17. The sample will consist of patients admitted to a third level neuropsychiatric unit, belonging to one of the following three subgroups: 1) adolescents with established Diagnostic and Statistical Manual of Mental Disorder–Fifth Edition psychosis, 2) adolescents with CHR-P, and 3) adolescents with psychiatric symptoms other than established psychosis or CHR-P. The primary aim of our study is to evaluate the 2-year prognosis across the three groups. We will measure transition to psychosis (or the stability of the diagnosis of psychosis in the psychotic group), the risk of development of other psychiatric disorders, as well as socio-occupational functioning at outcome. The secondary aim will be to explore the effect of specific predictors (clinical, neuropsychological and neuroimaging factors) on the prognosis. At baseline, 1-year and 2-year follow-up participants will be assessed using standardized semi-structured interviews and instruments. Psychopathological and functioning variables, as well as neuropsychological domains will be compared across the three subgroups. Moreover, at baseline and 2-year follow-up all recruited patients will undergo a 3-Tesla magnetic resonance imaging examination and diffusion tensor imaging parameters will be analyzed. We believe that this study will advance our ability to predict outcomes in underage CHR-P samples. In particular, our data will enable a better understanding of the clinical significance of CHR-P in adolescents, and shed new light on prognostic factors that can be used to refine the prediction of clinical outcomes and the implementation of preventive interventions.
Highlights
During adolescence, the assessment of psychiatric symptoms and disorders is challenging
The primary aim of this study is to evaluate the 2-year prognosis in adolescent patients through three diagnostics groups: 1) with established DSM5 psychosis, 2) with Clinical High Risk of developing Psychosis (CHR-P), and 3) with other psychiatric disorders other than psychosis or CHR-P
Transition to psychosis will be evaluated according to the Comprehensive Assessment of At Risk Mental States (CAARMS) criteria
Summary
The assessment of psychiatric symptoms and disorders is challenging. Efforts have been devoted to develop diagnostic instruments and interviews that could help clinicians in differentiating between normal adolescent behaviors and psychiatric symptoms in this age range [4,5,6]. In a recent study [24], the authors identified a factor structure composed of social-cognitive bias, reflective self (selfesteem, resilience, physical anhedonia and social anhedonia), neurocognition and pre-reflective self (magical ideation, perceptual aberration and basic symptoms) factors These factors were different between recent-onset patients with schizophrenia, ultra-high risk for psychosis and healthy controls, but were associated with baseline quality of life both in CHR-P individuals and psychotic patients. The study protocol described here aims at filling these gaps in knowledge, with a longitudinal, broad risk approach, driven by the increasing need to refine the ability to predict different clinical outcomes in this population [51]
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