Assessment of adolescents at risk for psychosis

Abstract

Early intervention in schizophrenia is an emerging goal of research investigating the earliest phases of the illness, which occur predominantly in adolescence and young adulthood. In order to develop strategies for early intervention, individuals at highest risk for the development of psychosis must be accurately identified. Here we briefly review the historical approaches to the assessment of risk for schizophrenia and highlight the more recently developed interview-based methods for the assessment of incipient psychosis, with particular attention paid to their applicability in adolescence. We present a prototypical assessment battery that includes an integration of historical assessment approaches to form a comprehensive assessment of threshold and subthreshold psychopathology, and other assessment procedures targeted specifically at adolescents. This battery may assist in unraveling the complex presentation of prodromal symptoms during the adolescent developmental period.

Computerized neurocognitive profile in young people with 22q11.2 deletion syndrome compared to youths with schizophrenia and At‐Risk for psychosis

“…All participants in this group had a deletion of the 22q11.2 region (3MB [18 participants], 1.7Mb [2], atypical [1] (SLC25A18-CLDN5)). The non-deleted participants were recruited from the University of Pennsylvania Schizophrenia Research Center [Borgmann-Winter and others 2006] and included 21 low risk participants (no putatively prodromal symptoms and no family history of psychosis in a first-degree relative), 21 patients with schizophrenia, 19 participants exhibiting prodromal symptoms (clinical risk), and 20 siblings of probands with schizophrenia (genetic risk). Among clinical risk participants, six had a first-degree relative with schizophrenia.…”

“…These interviews were performed by trained interviewers and reviewed in a consensus conference to arrive at risk group determination and best estimate final diagnosis. For details regarding the clinical assessment, see Borgmann-Winter and others [2006]. …”

The ‘At-Risk Mental State’ for Psychosis in Adolescents: Clinical Presentation, Transition and Remission

“…Moreover, possible signs and symptoms of the ARMS in this age group lack specificity [1] and may represent neuro-maturational and psychological changes occurring naturally during adolescence [13,14]. Subclinical psychotic symptoms also appear transitory in children [15] and adolescents [16] and are frequently reported by non-help seeking adolescent populations [17][18][19] although the latter is also the case in adults [20].…”

MicroRNA dysregulation in psychiatric disease

“…Second, the symptoms of psychiatric illness have a developmental trajectory that parallels the maturation of the brain. The timing of peak disease risk for all psychiatric disorders overlaps with the substantial cortical dendritic pruning that occurs during adolescence (Feinberg, 1982; Kessler et al, 2005a), and, although there are clear prodromal signs for some disorders, outright symptoms such as psychosis are rare during childhood (Borgmann-Winter et al, 2006; Paus et al, 2008). Finally, a number of studies have found significant structural differences between schizophrenic and control brains, including decreased cortical neuron spine density, enlarged lateral ventricle size, and decreased hippocampal and cortical volume (Fatemi and Folsom, 2009; Schultz and Andreasen, 1999).…”