Risks and Protective Factors of the Prodromal Stage of Psychosis: A Literature Review

Abstract

Psychosis is a syndrome characterized by features of reality distortion such as delusions and hallucinations. It may occur as a primary mental disorder or secondary to a medical or neurological illness or substance abuse. Several genetic, environmental, and protective risk factors have been identified and require further study. Neurobiological damage at the onset of schizophrenia is the most active and destructive. Therefore, it is important to detect the prodromal phase of psychosis so that interventions can be started early and the onset of psychosis delayed. Herein, we review the relevant epidemiological data on psychosis, particularly in Saudi Arabia. In addition, the risk and protective factors of psychosis will be discussed. Recent findings have shown that psychosis development is affected by genetic and environmental factors. Psychotic disorders are considered a cause of disability and are, therefore, a substantial economic burden. Consequently, it is important to try and detect the psychosis in its prodromal stage, where intervention may slow its progression and improve general wellbeing. Several tools have been identified to screen for the prodrome of psychosis, one of which is the prodromal questionnaire-brief version. This has been shown to be a promising tool that can be self-administered by the patient in contrast to long interview-based tools, which are time-consuming and require a physician to perform. Despite the limited evidence in the literature, there have been significant improvements in the outcomes of patients with psychosis when treated in the prodromal period. In summary, this article provides psychiatrists and researchers with an overview of psychosis, its risk factors, the prodromal stage of psychosis, tools to detect the prodromal phase, and potential treatments during this phase.

Primary Psychosis: Risk and Protective Factors and Early Detection of the Onset

“…Family history is considered one of the strongest risk factors for primary psychosis [16], with a heritability (i.e., the degree to which a phenotype, in this case a disorder, is genetically determined, calculated by regression-correlation analyses among close relatives) of schizophrenia estimated around 79-81% and a similar proportion in other disorders of the spectrum [17,18]. In particular, for close biologic relatives of patients with schizophrenia [13,19,20] was demonstrated a 7.5-fold higher risk for the development of primary psychosis [21] and studies on monozygotic twins [13,19,20] showed a concordance rate of approximately 50% [20,22].…”

“…As regards personality, many personality characteristics have been found to be implicated in the risk of developing primary psychosis, even though the majority of them showed a weak statistical association [15,16,24]. In particular, novelty seeking, harm avoidance, self-transcendence [15,24] and neuroticism [15,16] seem to increase the risk of developing primary psychosis, even if researchers agree that the most implied personality aspect is trait anhedonia [15,24].…”

“…Focusing on the GE interplay of early life traumas, different studies reported an rGE correlation showing that the offspring of a parent affected by psychosis is more prone to be exposed to dysfunctional elements of the family environment, as in the case of parental communication deviance [16]. Moreover, the effect of childhood trauma in increasing the risk or psychosis has been found to be partially independent from a previous genetic susceptibility [56].…”

“…Regarding their role, they do not necessarily promote normal evolution in the absence of risk factors, but they may make a remarkable difference in the influence of risk factors [75]. Notably, a positive environment might play a role in protecting genetically susceptible individuals, especially during the vulnerable adolescence period [16].…”

Magnetic Resonance Imaging-Based Connectomics in First-Episode Schizophrenia: From Preclinical Study to Clinical Translation

“…As mentioned earlier, prodrome is important for the diagnosis and treatment of schizophrenia (34). Therefore, several tools were created to detect the prodromal stage of psychosis (45). Intervention in the prodrome stage has been reported to improve cure rates and prognosis (46).…”