The psychosis risk timeline: can we improve our preventive strategies? Part 3: primary common pathways and preventive strategies

Abstract

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.

The psychosis risk timeline: can we improve our preventive strategies? Part 2: adolescence and adulthood

“…Potential risk factors are summarised in Box 2, but it should be noted that the evidence base for some of these is sparse. The next and final article in the series (Romain 2019b) focuses on: the final common pathways leading to psychosis; neurochemistry, neurostructure and inflammation; and possible primary, secondary and tertiary preventive strategies.

Potential psychosis risk factors in adolescence and adulthood Living environment Urban livingLow socioeconomic statusFrequent environment changeMigrationBeing a refugee Communicative environment Parental schizophreniaPoor parent–child relationshipsSocial defeat (prolonged exposure to social exclusion or adversity)Social cognition and emotionImpaired theory of mindPoor affect recognitionThought disorder, reduced ideational richnessImpaired motivation and isolation Psychopathology Depression and anxiety disordersBehavioural problemsAltered personality profiles (e.g.

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“…They reported that the psychotic states induced by certain drugs of misuse are related to their actions on different neurotransmitters: lysergic acid diethylamide (LSD) is thought to cause serotonergic abnormalities, amphetamines have a dopaminergic action, phencyclidine (PCP) and ketamine act on glutamate pathways, and the endocannabinoid system is activated in cannabis use. These primary pathways are considered further in part 3 of this series (Romain 2019b). Overall drug misuse has helped us to develop our current understanding of psychosis development.…”

“…1). In part 1 (Romain 2019a) we discussed early-life risk factors and in part 3 (Romain 2019b) we will examine the final common pathways to psychosis and possible preventative strategies which may help to ameliorate the risks. Overall, this series aims to update knowledge of risk factors for psychosis and provide a basis for discussion focused on making positive changes for the future.…”

The psychosis risk timeline: can we improve our preventive strategies? Part 1: early life

“…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.…”

A case for psychosocial interventions to prevent mental illness

“…The three articles by Romain and colleagues in this issue (Romain 2019a, 2019b, 2019c) provide an excellent overview of the risk factors implicated in the cause of psychosis, which are thus potential targets for prevention. Preventive interventions can be either universal, in so far as some approaches benefit everyone, including those at risk, or targeted on a subpopulation because they are considered vulnerable to a specific disorder.…”