The Significance of At-Risk Symptoms for Psychosis in Children and Adolescents

Abstract

The early detection and treatment of people at risk for psychosis is currently regarded as a promising strategy in fighting the devastating consequences of psychotic disorders. Currently, the 2 most broadly used sets of at-risk criteria, that is, ultra-high risk (UHR) and basic symptom criteria, were developed mainly in adult samples. We review the data regarding the presence and relevance of at-risk symptoms for psychosis in children and adolescents. The few existing studies suggest that attenuated psychotic symptoms (APS) and brief limited intermittent psychotic symptoms (BLIPS) do have some clinical relevance in young adolescents from the general population. Nevertheless, their differentiation from atypical psychotic symptoms or an emerging schizotypal personality disorder, as well as their stability and predictive accuracy for psychosis, are still unclear. Further, standard interviews for UHR criteria do not define a minimum age for the assessment of APS and BLIPS or guidelines as to when and how to include information from parents. APS and basic symptoms may be predictive of conversion to psychosis in help-seeking young adolescents. Nevertheless, the rate and timing, and thus the required observation time, need further study. Moreover, no study has yet addressed the issue of how to treat children and adolescents presenting with at-risk symptoms and criteria. Further research is urgently needed to examine if current at-risk criteria and approaches have to be tailored to the special needs of children and adolescents. A preliminary rationale for how to deal with at-risk symptoms for psychosis in clinical practice is provided. W W W La signification des symptômes à risque de psychose chez les enfants et les adolescentsLa détection et le traitement précoces des personnes à risque de psychose sont actuellement réputés constituer une stratégie prometteuse pour combattre les conséquences désastreuses des troubles psychotiques. À l'heure actuelle, les 2 ensembles les plus utilisés de critères à risque, c'est-à-dire, le risque ultra-élevé (RUE) et les critères des symptômes de base, ont été développés principalement pour des échantillons adultes. Nous examinons les données au regard de la présence et de la pertinence des symptômes à risque de psychose chez les enfants et les adolescents. Les quelques études existantes suggèrent que les symptômes psychotiques atténués (SPA) et les symptômes psychotiques brefs, limités et intermittents (BLIPS) ont une certaine pertinence clinique chez les jeunes adolescents de la population générale. Néanmoins, leur différenciation des symptômes psychotiques atypiques ou d'un trouble de la personnalité schizotypique naissant, ainsi que leur stabilité et leur exactitude à prédire la psychose sont encore indéfinies. De plus, les entrevues standards pour les critères RUE ne fixent pas d'âge minimum pour l'évaluation des SPA et des BLIPS, ni n'offrent de guides sur le moment et la manière d'inclure l'information des parents. Les SPA et les symptômes de base peuvent prédire une conversion à...

Outcome of Youth with Early-Phase Schizophrenia-Spectrum Disorders and Psychosis Not Otherwise Specified Treated with Second-Generation Antipsychotics: 12 Week Results from a Prospective, Naturalistic Cohort Study

“…Treating patients in the early phases of psychosis may lead to better short and long-term outcomes, reducing the risk of more chronic impairment. Following this line of argument, identification of prodromal youth and intervention with the lowest risk treatment options during that earliest stage of illness development should also be aimed for (Correll et al 2010;Schimmelmann et al 2013b;Stafford et al 2013). Antipsychotics, however, should likely be avoided during the clinical high-risk stage, as the majority of people with attenuated positive symptoms will not go on to develop full-blown psychosis (Fusar-Poli et al 2012), which is also true for adolescents (Cornblatt et al 2015).…”

“…Early onset psychotic disorders are relatively rare, but usually quite severe (Rapado-Castro et al 2010), with research pointing to worse outcomes and prognosis for children and adolescents with psychotic disorders, especially schizophrenia, compared with adults (Clemmensen et al 2012). More children and adolescents present with adverse premorbid signs, such as neurocognitive deficits and poor social adjustment, as well as negative prognostic signs at onset, such as cognitive impairment, high level of negative symptoms, and insidious onset (Hassan and Taha 2011;Schimmelmann et al 2013b).…”

The psychosis spectrum in a young U.S. community sample: findings from the Philadelphia Neurodevelopmental Cohort

“…However, through longitudinal evaluation, they provide a window to examine neurobiological risk and protective factors associated with various outcomes (4). This window may be widened by evaluating the earliest emergence of subclinical spectrum symptoms in younger people from the general population (8). Symptom onset before age 18 is a significant predictor of psychosis conversion in ultra-high risk (9) and birth cohort (7,8,10) samples.…”

Stimulant Medication and Psychotic Symptoms in Offspring of Parents With Mental Illness

“…[37][38][39] It should be noted that most stimulantassociated psychotic symptoms were hallucinations and there is lack of consensus about the predictive value of hallucinations in children. Some authors suggest that hallucinations in children have a relatively good prognosis [37][38][39][40] unless they are accompanied by delusions. 41,42 On the other hand, PLEs that were overwhelmingly hallucinations predicted psychotic symptoms and disorders in adulthood in several large cohorts.…”