Preventive treatments in patients at high risk of psychosis

Kuharić, Dina Bošnjak; Kekin, Ivana; Hew, J.T.; Kuzman, Martina Rojnić; Puljak, Livia

doi:10.1016/s2215-0366(20)30100-0

Cited by 3 publications

(2 citation statements)

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“…Without providing any meta‐analytical counter‐evidence, some authors have complained that evidence needs to be contextualized, because the “potential for improvement is a key message for patients, families, and practitioners” 242 . The Cochrane authors replied that their meta‐analysis was not a criticism of the valuable preventive aims, but only scientific grading of the available evidence 243 .…”

Section: Future Directions Of Research and Practicementioning

confidence: 99%

Preventive psychiatry: a blueprint for improving the mental health of young people

et al. 2021

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Preventive approaches have latterly gained traction for improving mental health in young people. In this paper, we first appraise the conceptual foundations of preventive psychiatry, encompassing the public health, Gordon's, US Institute of Medicine, World Health Organization, and good mental health frameworks, and neurodevelopmentally‐sensitive clinical staging models. We then review the evidence supporting primary prevention of psychotic, bipolar and common mental disorders and promotion of good mental health as potential transformative strategies to reduce the incidence of these disorders in young people. Within indicated approaches, the clinical high‐risk for psychosis paradigm has received the most empirical validation, while clinical high‐risk states for bipolar and common mental disorders are increasingly becoming a focus of attention. Selective approaches have mostly targeted familial vulnerability and non‐genetic risk exposures. Selective screening and psychological/psychoeducational interventions in vulnerable subgroups may improve anxiety/depressive symptoms, but their efficacy in reducing the incidence of psychotic/bipolar/common mental disorders is unproven. Selective physical exercise may reduce the incidence of anxiety disorders. Universal psychological/psychoeducational interventions may improve anxiety symptoms but not prevent depressive/anxiety disorders, while universal physical exercise may reduce the incidence of anxiety disorders. Universal public health approaches targeting school climate or social determinants (demographic, economic, neighbourhood, environmental, social/cultural) of mental disorders hold the greatest potential for reducing the risk profile of the population as a whole. The approach to promotion of good mental health is currently fragmented. We leverage the knowledge gained from the review to develop a blueprint for future research and practice of preventive psychiatry in young people: integrating universal and targeted frameworks; advancing multivariable, transdiagnostic, multi‐endpoint epidemiological knowledge; synergically preventing common and infrequent mental disorders; preventing physical and mental health burden together; implementing stratified/personalized prognosis; establishing evidence‐based preventive interventions; developing an ethical framework, improving prevention through education/training; consolidating the cost‐effectiveness of preventive psychiatry; and decreasing inequalities. These goals can only be achieved through an urgent individual, societal, and global level response, which promotes a vigorous collaboration across scientific, health care, societal and governmental sectors for implementing preventive psychiatry, as much is at stake for young people with or at risk for emerging mental disorders.

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Section: Future Directions Of Research and Practicementioning

confidence: 99%

Preventive psychiatry: a blueprint for improving the mental health of young people

et al. 2021

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“…The first episode of psychosis (FEP) is a crucial stage in the course of schizophrenia, representing the transition from a premorbid to a morbid state. This stage is usually preceded by a "prodromal" period, during which subjects might present gradual and subtle changes in thoughts, perceptions, behaviors, cognition, and functioning (14)(15)(16). This period is associated with affective symptoms, social withdrawal, cognitive deficits, attenuated positive psychotic symptoms, and impairment in functioning, which is strongly related to cognitive deficits (17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

EEG-Based Measures in At-Risk Mental State and Early Stages of Schizophrenia: A Systematic Review

et al. 2021

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Introduction: Electrophysiological (EEG) abnormalities in subjects with schizophrenia have been largely reported. In the last decades, research has shifted to the identification of electrophysiological alterations in the prodromal and early phases of the disorder, focusing on the prediction of clinical and functional outcome. The identification of neuronal aberrations in subjects with a first episode of psychosis (FEP) and in those at ultra high-risk (UHR) or clinical high-risk (CHR) to develop a psychosis is crucial to implement adequate interventions, reduce the rate of transition to psychosis, as well as the risk of irreversible functioning impairment. The aim of the review is to provide an up-to-date synthesis of the electrophysiological findings in the at-risk mental state and early stages of schizophrenia.Methods: A systematic review of English articles using Pubmed, Scopus, and PsychINFO was undertaken in July 2020. Additional studies were identified by hand-search. Electrophysiological studies that included at least one group of FEP or subjects at risk to develop psychosis, compared to healthy controls (HCs), were considered. The heterogeneity of the studies prevented a quantitative synthesis.Results: Out of 319 records screened, 133 studies were included in a final qualitative synthesis. Included studies were mainly carried out using frequency analysis, microstates and event-related potentials. The most common findings included an increase in delta and gamma power, an impairment in sensory gating assessed through P50 and N100 and a reduction of Mismatch Negativity and P300 amplitude in at-risk mental state and early stages of schizophrenia. Progressive changes in some of these electrophysiological measures were associated with transition to psychosis and disease course. Heterogeneous data have been reported for indices evaluating synchrony, connectivity, and evoked-responses in different frequency bands.Conclusions: Multiple EEG-indices were altered during at-risk mental state and early stages of schizophrenia, supporting the hypothesis that cerebral network dysfunctions appear already before the onset of the disorder. Some of these alterations demonstrated association with transition to psychosis or poor functional outcome. However, heterogeneity in subjects' inclusion criteria, clinical measures and electrophysiological methods prevents drawing solid conclusions. Large prospective studies are needed to consolidate findings concerning electrophysiological markers of clinical and functional outcome.

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Evaluating Ratio Indices Based on Electroencephalogram Brainwaves in Schizophrenia Detection

Goshvarpour,

Goshvarpour

2024

J. Med. Biol. Eng.

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Preventive treatments in patients at high risk of psychosis

Cited by 3 publications

References 1 publication

Preventive psychiatry: a blueprint for improving the mental health of young people

Preventive psychiatry: a blueprint for improving the mental health of young people

EEG-Based Measures in At-Risk Mental State and Early Stages of Schizophrenia: A Systematic Review

Evaluating Ratio Indices Based on Electroencephalogram Brainwaves in Schizophrenia Detection

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