Protective Factors for Early Psychotic Phenomena Among Children of Mothers With Psychosis.

Simon Riches,Helen L. Fisher,Louise Arseneault,Raha Bagher-Niakan,Eloise Crush,Manar Alsultan

doi:10.3389/fpsyt.2018.00750

Simon Riches, Helen L. Fisher + Show 4 more

Open Access

https://doi.org/10.3389/fpsyt.2018.00750

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Abstract

Background: Early identification of sub-clinical psychotic experiences in at-risk individuals is vital to prevent the development of psychosis, even before prodromal symptoms emerge. A widely-replicated risk factor is having a family member with psychosis. The Environmental Risk (E-Risk) Longitudinal Twin Study has shown that better cognitive functioning, a stimulating family environment, and a cohesive community, are protective against psychotic experiences among children; while engaging in physical activity, social support, and a cohesive community are protective for adolescents. In the current study we investigate whether these factors also protect against the development of sub-clinical psychotic phenomena among children and adolescents in this cohort who are at high-risk of psychosis by having a mother with psychosis.Methods: Data were utilized from the E-Risk Longitudinal Twin Study, a nationally-representative cohort of 2,232 twin children born in England and Wales in 1994–1995 followed to age 18. Psychotic phenomena were assessed in private interviews with children at ages 12 and 18, and mothers were interviewed about their own experiences of psychosis when children were aged 10 and 12. Bivariate and multivariate logistic regression analyses explored associations between individual, family, and community-level putative protective factors and absence of age-12 psychotic symptoms and age-18 psychotic experiences in children whose mothers had a diagnosis of a psychosis-spectrum disorder and/or reported psychotic symptoms.Results: Higher IQ (OR = 0.97, 95% CI 0.94–1.00, P = 0.036) and living in a more socially cohesive neighborhood (OR = 0.88, 95% CI 0.79–0.98, P = 0.023) were independently protective against age-12 psychotic symptoms among children of mothers with psychosis. Higher levels of perceived social support were independently protective against age-18 psychotic experiences among children of mothers with psychosis (OR = 0.92, 95% CI 0.87–0.98, P = 0.006). However, there were no significant interactions between these protective factors and maternal psychosis in relation to an absence of childhood or adolescent psychotic phenomena in the full sample, indicating that protective effects were not specific to this group of high-risk children.Conclusions: These findings provide preliminary evidence that preventive interventions for early psychotic phenomena could focus on improving cognition, social support, and cohesiveness of the local community. Given scarce resources these might usefully be targeted at high-risk children.

Highlights

Psychotic disorders, especially schizophrenia, are responsible for a substantial proportion of disability worldwide [1], are associated with 10–25 years shorter life expectancy [2], and place a huge burden on families, health services, and society [3,4,5] Current treatments are unable to provide a cure; early identification of at-risk individuals may help to prevent the development of psychosis
Our findings suggest that high levels of neighborhood social cohesion are independently protective in children with mothers who have either symptoms or a diagnosis of psychosis, and in the whole population
Higher IQ and neighborhood social cohesion were found to be independently associated with a reduced likelihood of age-12 psychotic symptoms among children of mothers with symptoms of psychosis or a psychosis-spectrum diagnosis

Summary

Introduction

Especially schizophrenia, are responsible for a substantial proportion of disability worldwide [1], are associated with 10–25 years shorter life expectancy [2], and place a huge burden on families, health services, and society [3,4,5] Current treatments are unable to provide a cure; early identification of at-risk individuals may help to prevent the development of psychosis. Earlylife psychotic experiences are thought to lie on a continuum with psychotic disorders [9] and have been shown to predict elevated rates of schizophrenia by age 38 [10] and share many of the risk factors commonly associated with psychotic disorders [11] These sub-clinical psychotic phenomena have been shown to increase the risk for other psychiatric disorders [12], suicide attempts [10], and poor functional outcomes [13] in adulthood. Identification of sub-clinical psychotic experiences in at-risk individuals is vital to prevent the development of psychosis, even before prodromal symptoms emerge. In the current study we investigate whether these factors protect against the development of sub-clinical psychotic phenomena among children and adolescents in this cohort who are at high-risk of psychosis by having a mother with psychosis

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