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

Abstract

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.

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

“…1. This is thought to be a result of the genetic and environmental factors discussed previously (Romain 2019a, 2019b), including stress and substance misuse, on a background of decreased cortical plasticity. This abnormal connectivity has been linked to aberrant processing of language, auditory and visual stimuli, thus suggesting an association between abnormal plasticity and clinical psychopathology (Keshavan 2015).…”

“…Schizophrenia, and more broadly psychosis, research has often focused on the role of dopamine. Many of the risk factors discussed in parts 1 and 2 of this series (Romain 2019a, 2019b), for example, amphetamines, caffeine, isolation and childhood maltreatment, have been found to result in a variety of different alterations within the dopamine system.…”

“…This concluding article of a three-part series summarises current knowledge on the primary common pathways thought to contribute to psychosis risk. A range of risk factors have been identified in parts 1 and 2 of this series (Romain 2019a, 2019b) and these now come together with a focus on three final common pathways, overlapping and interacting with each other in a complex system. The three key mechanisms involved are: alterations in neurology, neurochemistry and inflammatory pathways.…”

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

“…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.…”

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.…”