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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.

COVID-19 pandemic is prompting multiple stressors -including control strategies such as lockdown- which may impact child and adolescent mental health. 1,529 caregivers answered an online questionnaire about emotional and behavioral symptoms of youths (4-18 years old) using the Pediatric Symptom Checklist (PSC). Percentage of above-the-risk-threshold PSC scores (PSC+) were compared with a baseline measure. Associations between lockdown PSC scores and selected variables were evaluated using a linear regression analysis. PSC+ significatively increased from 13% to 34.7%, baseline to lockdown, mostly driven by depression and anxiety symptoms and with greater risk at younger ages. Youths’ and parents’ positive mental health history additionally increased this risk. In children, caregivers’ stress and depression was the stronger predictor of lockdown PSC scores; in adolescents it was the coping style. These findings suggest a significant mental health impact on children and adolescents associated with COVID-19 pandemic response. Younger ages should be closely monitored.

Aim: Despite the interest in psychosis risk syndrome (PRS) in children and adolescents, information on the syndrome in this population is scarce.Methods: Prospective naturalistic multi-site study in which 10-to 17-year-old help-seeking subjects who met PRS criteria (positive or negative attenuated symptoms; brief limited intermittent psychotic symptoms; genetic risk or schizotypal personality disorder plus impairment in functioning) were included, along with 45 age and sex-matched healthy controls (HC). All subjects were clinically and functionally assessed. Results: Ninety-one PRS subjects (PRSS) with a mean age of 15.5 AE 1.4 met inclusion criteria (IC). Compared with HC, PRSS presented worse global and academic functioning in the previous year, had experienced more psychiatric and psychological problems, and presented gestational ages outside the normal range. More than 80% of PRSS met ≥2 IC, with 65.9% having one Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision diagnosis, and 61.7% of those having ≥2 diagnoses. Some 49.5% of PRSS had a first-or second-degree family history (FH) of psychosis. Patients with first-and second-degree FH do not differ in their clinical expression.Conclusions: Children and adolescents with PRS are a patient group with a pattern of neurodevelopmental impairment and clinical complexity similar to patients with schizophrenia spectrum disorders, highlighting the importance of assessing these variables in child and adolescent samples. PRSS with first-and second-degree relatives with FH do not present differences in their clinical presentation, suggesting that including these two groups of patients in the genetic risk criteria would enrich knowledge of these criteria. K E Y W O R D Schild and adolescent, clinical high risk for psychosis, psychosis, psychosis risk syndrome