Abstract
Primary psychosis, which includes schizophrenia and other psychoses not caused by other psychic or physical conditions, has a strong impact worldwide in terms of disability, suffering and costs. Consequently, improvement of strategies to reduce the incidence and to improve the prognosis of this disorder is a current need. The purpose of this work is to review the current scientific literature on the main risk and protective factors of primary psychosis and to examine the main models of prevention, especially those related to the early detection of the onset. The conditions more strongly associated with primary psychosis are socio-demographic and economic factors such as male gender, birth in winter, ethnic minority, immigrant status, and difficult socio-economic conditions while the best-established preventive factors are elevated socio-economic status and an economic well-being. Risk and protective factors may be the targets for primordial, primary, and secondary preventive strategies. Acting on modifiable factors may reduce the incidence of the disorder or postpone its onset, while an early detection of the new cases enables a prompt treatment and a consequential better prognosis. According to this evidence, the study of the determinants of primary psychosis has a pivotal role in designing and promoting preventive policies aimed at reducing the burden of disability and suffering of the disorder.
Highlights
Primary psychosis is a heterogeneous group of mental disorders that includes various diagnoses characterized by positive symptoms, disorganized thinking and/or motor behavior, and negative symptoms [1]
As for many other chronic diseases, genetic and environmental risk factors combine with each other increasing the likelihood of developing primary psychosis
GE will be used to indicate a general interplay between genetic and environmental factors, GxE to describe a random relationship, and rGE a non-random interaction where the presence of a specific genetic factor increases the likelihood of being exposed to a specific environmental determinant. rGE can be passive, evocative and active [13]
Summary
Primary psychosis is a heterogeneous group of mental disorders that includes various diagnoses characterized by positive symptoms (i.e., delusions and/or hallucinations), disorganized thinking and/or motor behavior, and negative symptoms (i.e., affective blunting, alogia, asociality, anhedonia, and avolition) [1]. Two main diagnostic systems are employed in psychiatry: the Diagnostic and Statistical Manual of mental disorders, 5th edition [2] and the International Classification of Diseases 11th Revision [3]. Both include diagnoses that meet the abovementioned diagnostic criteria for primary psychosis. The lifetime prevalence primary psychosis is around 1.94% [4] and schizophrenia, the most prevalent disorder of this group of diagnoses, is the 19th disease in terms of years lived with disability in both genders worldwide [5]
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