Understanding the genesis of psychotic disorder: Issues in the prediction and prophylaxis of those at ultra‐high risk

Abstract

Recent clinical research has used both retrospective and prospective means of identifying individuals at ultra-high risk and has made substantial gains in predicting transition. The clinical implications of their identification are discussed in the context of current pharmacological and psychosocial treatment studies. However, significant unresolved clinical and ethical issues remain with both types of study.

Early trauma and familial risk in the development of the extended psychosis phenotype in adolescence

“…The heritability of schizophrenia is currently estimated at around 60% (22). In line with this estimate are observations that the risk of developing psychosis for a non‐affected monozygotic cotwin of a person with schizophrenia is 50% (23, 24) and that up to 85% of patients with schizophrenia do not have a first‐ or second‐generation relative with psychotic disorder (25). Genes and environment are unlikely to act in isolation (1).…”

A latent class analysis of positive psychosis symptoms based on the British Psychiatric Morbidity Survey

“…Research identifying such cases of risk has increased and much of this research adheres to the premise that psychosis exists along a P r e -P r i n t A latent class analysis of positive psychosis symptoms 4 continuum of symptom severity and that clinically defined psychosis merely represents the extreme end of the distribution (Mason, & Beavan-Pearson, 2005).…”

14:15 Persistence of the Extended Psychosis Phenotype in Young People: Link Between Vulnerability and Clinical Need

“…In line with this estimate are observations that the risk of developing psychosis for a non affected monozygotic co twin of a person with schizophrenia is 50% (Harrison & Weinberger, 2005;Mittal, Ellman, & Cannon, 2008) and that up to 85% patients with schizophrenia do not have a first or second generation relative with psychotic disorder (Mason & Beavan Pearson, 2005). Genes and environment are unlikely to act in isolation .…”

“…The notion of a neurodevelopmental pathway already has a long history (Murray & Lewis, 1987;Weinberger, 1987). In youngsters on this pathway, early deviations in biology, social development and personality, cognition and motor activity (Cannon et al, 2002;Lewis & Levitt, 2002;Mason & Beavan Pearson, 2005;Welham et al, 2009) are present long before onset of the distinct features of clinical psychosis. Individuals who in the current thesis are identified as having persistently high levels of psychotic experiences may be on such a neurodevelopmental pathway to psychosis.…”