Abstract:SUMMARYCurrent understanding of psychosis development is relevant to patients' clinical outcomes in mental health services as a whole, given that psychotic symptoms can be a feature of many different diagnoses at different stages of life. Understanding the risk factors helps clinicians to contemplate primary, secondary and tertiary preventive strategies that it may be possible to implement. In this second article of a three-part series, the psychosis risk timeline is again considered, here focusing on risk fac… Show more
“…Potential risk factors are summarised in Box 3, but it should be noted that the evidence for many of these is equivocal. In part 2 (Romain 2019a), this risk timeline is continued into later childhood, adolescence and adulthood, discussing substance misuse, psychological and other environmental factors in preparation for the final article (Romain 2019b), which considers final common pathways and primary, secondary and tertiary preventive options for the future. Potential early-life risk factors for psychotic disorders Genetics There is thought to be high heritability: 79% for schizophrenia and 73% for schizophrenia spectrum disordersSpecific genes have been linked to increased risk of psychosis: 3q29DISC122q11.2 DSNMDA receptorNeurexins17q12 deletion See Table 1 for futher genes Parental risk factors Factors related to parental ageMaternal high body mass index during or prior to pregnancyLower parental, particularly maternal, educationMaternal exposure to severe emotional trauma during pregnancy Prenatal development and birth Abnormalities in fetal brain developmentPremature birthA high obstetric complication index scoreLow retinol during the second trimesterMaternal substance misuse during pregnancyBirth during the winter or springPrenatal exposure to infectious diseases, e.g.…”
Section: Discussionmentioning
confidence: 99%
“…It is therefore important to keep up to date with current research findings so that effective preventive and supportive strategies can be put in place. We have divided our examination of this area into a three-part series (see also Romain 2019a,b). Different risk factors, not just for schizophrenia but for psychotic symptoms in general, will be addressed in accordance with the timeline shown in (Fig.…”
SUMMARYPsychosis is a complex presentation with a wide range of factors contributing to its development, biological and environmental. Psychosis is a feature present in a variety of psychiatric disorders. It is important for clinicians to keep up to date with evidence regarding current understanding of the reasons psychosis may occur. Furthermore, it is necessary to find clinical utility from this knowledge so that effective primary, secondary and tertiary preventative strategies can be considered. This article is the first of a three-part series that examines contemporary knowledge of risk factors for psychosis and presents an overview of current explanations. The articles focus on the psychosis risk timeline, which gives a structure within which to consider key aspects of risk likely to affect people at different stages of life. In this first article, early life is discussed. It covers elements that contribute in the prenatal and early childhood period and includes genetic, nutritional and infective risk factors.LEARNING OBJECTIVESAfter reading this article you will be able to:
•give an up-to-date overview of psychosis risk factors that can affect early life•describe some important genetic risk factors•understand more about the role of environmental factors such as nutrition and infection.DECLARATION OF INTERESTNone.
“…Potential risk factors are summarised in Box 3, but it should be noted that the evidence for many of these is equivocal. In part 2 (Romain 2019a), this risk timeline is continued into later childhood, adolescence and adulthood, discussing substance misuse, psychological and other environmental factors in preparation for the final article (Romain 2019b), which considers final common pathways and primary, secondary and tertiary preventive options for the future. Potential early-life risk factors for psychotic disorders Genetics There is thought to be high heritability: 79% for schizophrenia and 73% for schizophrenia spectrum disordersSpecific genes have been linked to increased risk of psychosis: 3q29DISC122q11.2 DSNMDA receptorNeurexins17q12 deletion See Table 1 for futher genes Parental risk factors Factors related to parental ageMaternal high body mass index during or prior to pregnancyLower parental, particularly maternal, educationMaternal exposure to severe emotional trauma during pregnancy Prenatal development and birth Abnormalities in fetal brain developmentPremature birthA high obstetric complication index scoreLow retinol during the second trimesterMaternal substance misuse during pregnancyBirth during the winter or springPrenatal exposure to infectious diseases, e.g.…”
Section: Discussionmentioning
confidence: 99%
“…It is therefore important to keep up to date with current research findings so that effective preventive and supportive strategies can be put in place. We have divided our examination of this area into a three-part series (see also Romain 2019a,b). Different risk factors, not just for schizophrenia but for psychotic symptoms in general, will be addressed in accordance with the timeline shown in (Fig.…”
SUMMARYPsychosis is a complex presentation with a wide range of factors contributing to its development, biological and environmental. Psychosis is a feature present in a variety of psychiatric disorders. It is important for clinicians to keep up to date with evidence regarding current understanding of the reasons psychosis may occur. Furthermore, it is necessary to find clinical utility from this knowledge so that effective primary, secondary and tertiary preventative strategies can be considered. This article is the first of a three-part series that examines contemporary knowledge of risk factors for psychosis and presents an overview of current explanations. The articles focus on the psychosis risk timeline, which gives a structure within which to consider key aspects of risk likely to affect people at different stages of life. In this first article, early life is discussed. It covers elements that contribute in the prenatal and early childhood period and includes genetic, nutritional and infective risk factors.LEARNING OBJECTIVESAfter reading this article you will be able to:
•give an up-to-date overview of psychosis risk factors that can affect early life•describe some important genetic risk factors•understand more about the role of environmental factors such as nutrition and infection.DECLARATION OF INTERESTNone.
“…Neurostructure, function and development are frequently implicated as pathways by which psychosis risk factors lead to significant biological changes and symptom expression. For example, in part 2 of this series (Romain 2019b) we discussed evidence that childhood maltreatment could alter neurostructure, particularly hippocampal development (Teicher 2012). Other factors discussed in this series that might increase risk for psychosis via neurodevelopment, plasticity and structure include, among others, cannabis use, sleep difficulty, genetic factors and perinatal difficulties.…”
Section: Pathway 1: Neurological Structure and Functionmentioning
confidence: 99%
“…The last pathway considered in our three articles is the inflammatory pathway and we have focused on how risk factors influence it. For example, in parts 1 and 2 (Romain 2019a, 2019b) we considered the role of infection and pollution, and throughout have considered the role of stress. This is the most recently developed of the three primary pathways considered and is the focus of a large body of ongoing research.…”
Section: Pathway 3: Inflammationmentioning
confidence: 99%
“…We advocate ongoing targeted interventions to reduce substance misuse, in light of our review of this evidence in part 2 (Romain 2019b). Although research in this area is difficult, owing to the nature of the substances and ethical considerations, overall there is significant evidence to link many substances with increased psychosis risk.…”
SUMMARYPsychosis is a recognised feature of several psychiatric disorders and it causes patients significant distress and morbidity. It is therefore important to keep knowledge of possible risk factors for psychosis up to date and to have an overview model on which further learning can be structured. This article concludes a three-part series. It gives a review of evidence regarding common pathways by which many risk factors come together to influence the development of psychosis and finalises our suggested overview model, a psychosis risk timeline. The three primary pathways considered are based on the major themes identified in this narrative review of recent literature and they focus on neurological, neurochemical and inflammatory changes. We link each back to the factors discussed in the first and second parts of this series that alter psychosis risk through different mechanisms and at different stages throughout life. We then consider and summarise key aspects of this complex topic with the aim of providing current and future clinicians with a model on which to build their knowledge and begin to access and understand current psychosis research and implications for future preventive work.LEARNING OBJECTIVESAfter reading this article you will be able to:
•give an overview of common pathways thought to link identified risk factors with psychosis development•understand neurochemical, neurostructural and inflammatory changes associated with psychosis•demonstrate increased knowledge of possible preventive strategies.DECLARATION OF INTERESTNone.
SUMMARYThe development of effective preventions for psychosis is hindered by conceptual challenges underlying diagnosis and the fact that few of the many biological risk factors identified to date are sufficiently well understood to form the basis of a targeted intervention. On the other hand, a great deal is known of the psychosocial conditions that increase the lifetime risk of most mental illnesses: surely enough to justify better resourcing of interventions focused on antenatal care and the emotional well-being of children from the early years through adolescence, where as much as a half of all mental ill health has its roots.DECLARATION OF INTERESTNone.
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