A neurodevelopment and neuroplasticity-based framework for early intervention in psychotic disorders

Abstract

In recent years there has been growing interest in early intervention in psychotic disorders and a number of clinical and research programmes have been developed. The clinical staging model has been an essential part of early intervention as it provides the rationale of existing programmes. In medicine, clinical staging is a valuable approach in disorders where primary pathology is progressive in nature. However, the clinical staging model of psychosis has been proposed without establishing first that schizophrenia is a primarily progressive disorder. In reviewing existing evidence, this current paper argues that cross-sectional data interpreted as supportive of clinical staging data does not consider the effects of sampling bias, problems in reliability in assessing 'soft symptoms', or false positives. Longitudinal neurobiological studies do not provide a convincing case for primarily progressive pathology in schizophrenia. Clinical progression in schizophrenia can be better conceptualised as neuroplastic changes in response to interaction between core developmental pathology and environmental stimuli. An alternative rationale for early and continuous intervention targeting neurodevelopmental abnormality and neuroplastic changes, as well as medical and psychological comorbidities, is proposed in this paper.

Reduced brain-derived neurotrophic factor is associated with childhood trauma experiences and number of depressive episodes in severe mental disorders

“…The current study has some limitations. The relevance of a staging model for schizophrenia has been questioned (Bora et al, 2017). Furthermore, investigating numbers of episodes as a marker of staging and clinical severity may be biased by disease characteristics.…”

Accelerating research on treatment and services for transition age youth and adults on the autism spectrum

“…Interestingly, the adult schizophrenia literature makes use of both neurodevelopmental and neuroplasticity theories and has emphasized early or preventative interventions for adolescents and adults (Bora, 2017). In fact, schizophrenia research over the past decades has demonstrated that early intervention positively affects adult neural connectivity and functional skill levels, resulting in more positive life outcomes (Buonocore et al, 2017; Lee et al, 2012; Ramsay and Macdonald, 2015).…”

Letter to the Editor: The half-alive concept of schizophrenia is still better than the spectrum of everything

“…In fact, interventions for the ill-defined transdiagnostic subclinical PSD in youth is not much different from interventions for a category of ‘youth with distress’. While there is no doubt that non-specific and general interventions for mild psychiatric presentations in youth (in any age group) might be helpful, accepting this approach as the ultimate goal would hamper the efforts to develop disorder-specific effective and true early intervention strategies for modifying the outcome of psychotic disorders (Bora, 2017).…”