Early Detection and Treatment of Psychosis: The Bern Child and Adolescent Psychiatric Perspective

Abstract

Commonly conceptualized as neurodevelopmental disorders of yet poorly understood aetiology, schizophrenia and other nonorganic psychoses remain one of the most debilitating illnesses with often poor outcome despite all progress in treatment of the manifest disorder. Drawing on the frequent poor outcome of psychosis and its association with the frequently extended periods of untreated first-episode psychosis (FEP) including its prodrome, an early detection and treatment of both the FEP and the preceding at-risk mental state (ARMS) have been increasingly studied. Thereby both approaches are confronted with different problems, for example, treatment engagement in FEP and predictive accuracy in ARMS. They share, however, the problems related to the lack of understanding of developmental, that is, age-related, peculiarities and of the presentation and natural course of their cardinal symptoms in the community. Most research on early detection and intervention in FEP and ARMS is still related to clinical psychiatric samples, and little is known about symptom presentation and burden and help-seeking in the general population related to these experiences. Furthermore, in particular in the early detection of an ARMS, studies often address adolescents and young adults alike without consideration of developmental characteristics, thereby applying risk criteria that have been developed predominately in adults. Combining our earlier experiences described in this paper in child and adolescent, and general psychiatry as well as in both lines of research, that is, on early psychosis and its treatment and on the early detection of psychosis, in particular in its very early states by subjective disturbances in terms of basic symptoms, age-related developmental and epidemiological aspects have therefore been made the focus of our current studies in Bern, thus making our line of research unique.

Development and Long-Term Acceptability of ExPRESS, a Mobile Phone App to Monitor Basic Symptoms and Early Signs of Psychosis Relapse

“…Basic symptoms are subtle, subjective changes in individuals’ experiences of themselves (eg, difficulty managing attention) and the world around them (eg, more vivid colors) that predict first episodes of psychosis [16,17] and might predict relapses [18-20]. The most comprehensive studies to date have been retrospective [18,19].…”

Treatment Approaches for First Episode and Early-Phase Schizophrenia in Adolescents and Young Adults: A Delphi Consensus Report from Europe

“…[1][2][3]11,12 Compared to adult-onset schizophrenia, the diagnostic process is complex given the preceding psychopathology (also termed the clinical high-risk stage), 13,14 many ongoing physiological changes and peak time emergence of other mental disorders during this developmental age, 10 when disruption of early neurodevelopmental patterns can occur, particularly during the prenatal/perinatal period and adolescence. [15][16][17][18][19][20][21] Genetic susceptibility enhanced by environmental or chemical factors and traumatic events appears to trigger an abnormal development of some brain regions, resulting in alteration of white matter, greater loss of grey matter, excess synaptic pruning, and dysregulation of stress signalling pathways. [16][17][18][19]22 The differentiation of impairments in brain connectivity depends on the developmental period during which these triggers act, influencing disease onset and trajectory.…”

Neurophysiology for Detection of High Risk for Psychosis

“…Research in this area has aimed to develop tools that provide predictive information regarding early prevention methods [ 3 , 4 ]. Neurophysiological measures, such as mismatch negativity (MMN), are considered to be ideal measures of brain functioning associated with psychopathology due to the fact that they are generally easy to record and often can assess the brain's responses to stimuli in the absence of attention or motivation [ 5 ].…”