Risk factors for the adolescent-onset psychosis, with special emphasis on the role of the family

Abstract

Background: Adolescent-onset psychosis usually is the result of a long process of gradual decompensation, with several risk factors: biological, psychological and social factors. In adolescents who are burdened with the genetic, neurobiological vulnerability to psychosis, family influence can sometimes be pathological in terms of deviant communication that contributes to development of psychosis. Aim of the study was to determine whether there is a statistically significant relationship between adolescent-onset psychosis, and specific conditions in which adolescents live, whether psychosis is more common in young people living in families or in social care institutions. The sample was composed of two comparative groups of patients - a group of adolescents who live in families (N = 50), and a group of adolescents who live in social care institutions (N = 50). All of them were treated under the diagnoses of psychosis, severe depression and conduct disorders. Methods: New questionnaire was made for the study, and it covers the following information: gender, age, information on whether adolescent lives in a family or in social care institution, data on suicidality, information on psychoactive substance abuse, data on pharmacotherapy and psychotherapy, as well as the diagnosis that is formed on the basis of the auto-anamnesis and hetero-anamnesis, psychological and psychiatric exploration, the results of clinical laboratory analysis. Diagnoses were made according to the criteria of ICD-10. Results: Psychosis was significantly more common in young people living in families (?2= 13.562, df=1, p=0.000). There was no statistically significant relationship between gender of subjects, and the onset of psychosis. Living conditions are not associated with the development of depression. Depression is more common in girls (?2 = 4.927, df = 1, p = 0.026), while conduct disorder is more common in boys (?2 = 4.864, df = 1, p = 0.027). Conclusion: Inadequate communication within the family, especially existence of ?double bind? messages and mutual emotional distance, significantly, contributes to the development of psychosis in adolescents, as opposed to communication in social care institutions, where rules are clearly structured, communication with residents is organized mainly as professional work, and based on the legal norms and standards.