The concept of being at risk for psychosis has been introduced both for adults and children and adolescents, but fewer studies have been conducted in the latter population. The aim of this study is to systematically review the articles associated with clinical description, interventions, outcome and other areas in children and adolescents at risk for psychosis. We searched in MEDLINE/PubMed and PsycINFO databases for articles published up to 30/06/16. Reviewed articles were prospective studies; written in English; original articles with Clinical High Risk (CHR) for psychosis samples; and mean age of samples younger than 18 years. From 103 studies initially selected, 48 met inclusion criteria and were systematically reviewed. Studies show that CHR children and adolescents present several clinical characteristics at baseline, with most attenuated positive-symptom inclusion criteria observed, reporting mostly perceptual abnormalities and suspiciousness, and presenting comorbid conditions such as depressive and anxiety disorders. CHR children and adolescents show lower general intelligence and no structural brain changes compared with controls. Original articles reviewed show rates of conversion to psychosis between 17 and 20% at 1 year follow-up and between 7 and 21% at 2 years. While 36% of patients recovered from their CHR status at 6-year follow-up, 40% still met CHR criteria. Studies in children and adolescents with CHR were conducted with different methodologies, assessments tools and small samples. It is important to conduct studies on psychopharmacological and psychological treatment, as well as replication of the few studies found.

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BackgroundHigh-risk symptoms for psychosis (HRS) and substantial functional impairment occurs early in the course of psychosis (Fusar-Poli et al., 2015). Many patients with HRS are adolescents who are still living at home and are highly reliant on their relatives for support. Objectives: (1) To compare the family burden of caregivers of adolescents with HRS with carers of an age and gender matched healthy control group (HC), (2) to examine the relationships between different family burden aspects and high-risk symptoms for psychosis in the HRS sample.MethodsSample: 68 HRS subjects (15.3 ± 1.7 years, 66% females) and 42 HC subjects (15.5 ± 1.5 years, 66% females) from a prospective longitudinal study including help-seeking subjects who met HRS criteria (Child and Adolescent Psychiatry and Psychology departments of Hospital Clínic and Sant Joan de Déu, Barcelona, Spain). Inclusion criteria: age 10–17 years, meeting criteria for 1) attenuated positive or negative symptoms in the previous 12-months, 2) brief intermittent psychotic symptoms, 3) first or second degree relative with schizophrenia or schizotypical disorder plus impairment of functioning. Exclusion criteria: IQ<70, having a diagnosis of ASD. For HC subjects, exclusion criteria were having 1st or 2nd degree familiar with a psychotic disorder; a diagnosis of ASD and/or IQ<70. Instruments: the Semistructured Interview for Prodromal Syndromes and Scale of Prodromal Symptoms (SIPS/SOPS), the Hamilton Depression Scale and the Young Mania Scale for affective symptoms, a cognitive battery and the Caregiver Burden Inventory (CBI) which is a measure of family burden that has been validated in first-episode patients (McCleery et al., 2007). Caregivers’ responses are rated on a Likert scale from 0 (not at all descriptive) to 4 (very descriptive) and distributed in 5 factors: Time-Dependence Burden (T-Db), Developmental Burden (Db), Physical Burden (Pb), Social Burden (Sb), and Emotional Burden (Eb). High scores indicate greater perceived burden.ResultsHRS and HC subjects did not significantly differ in age (t=0.68, p=0.497) and sex (X2=0.003, p=0.958). Intellectual quotient was higher in HC (mean=105.4 ± 11.28) than in HRS subjects (98.63 ± 14.27, t=2.53, p=0.013). Mean scores of high-risk symptoms in HRS subjects were higher than in HC subjects (t>-9.35, p<0.001): positive: 9.12 ± 4.76, negative:11.16 ± 5.49, disorganitzation:4.96 ± 3.03, general: 8.22 ± 3.83, and total symptoms:33.24 ± 12.59. HRS subjects had also higher scores in depressive (10.54 ± 7.54, t=-9.75, p<0.001) and manic symptoms (3.61 ± 4.53, t=-5.10, p<0.001). Caregivers of HRS subjects showed higher scores than caregivers of HC in all CBI subscales (t>-5.59, p<0.001; T-Db: 6.36 ± 5.01 vs 1.02 ± 1.60, Db: 7.42 ± 6.51 vs 0.45 ± 1.23, Pb: 7.00 ± 6.13 vs 0.58 ± 1.80, Sb: 4.77 ± 4.66 vs 0.64 ± 1.95, Eb: 4.86 ± 4.64 vs 0.93 ± 2.66). Time-Dependence burden reported by caregivers of HRS patients was significantly correlated with the SOPS total score (r=0.303, p=0.014) and with the negative SOPS subs...

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