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Poletti M, Raballo A. Schizophrenia spectrum disorders in children and adolescents: Clinical, phenomenological, diagnostic, and prognostic features across subtypes. Schizophr Res 2024; 274:189-198. [PMID: 39341098 DOI: 10.1016/j.schres.2024.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/13/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024]
Abstract
Schizophrenia spectrum disorders (SSD) typically have a diagnostically recognizable onset in young adulthood, yet it is not unusual that help-seeking due to initial SSD-related clinical manifestations emerge in earlier developmental phases, such as childhood and adolescence. Varieties of SSD manifestations in children and adolescents can be distinguished according to variations in clinical expressivity, severity and timing (i.e. developmental stage). Some individuals may reach the full clinical threshold for a diagnosis of schizophrenia according to the same descriptive diagnostic criteria used for adults, and in this case, it's possible to distinguish a pre-pubertal onset in childhood (aka Very Early Onset Schizophrenia, VEOS) and a post-pubertal onset in adolescence (aka Early Onset Schizophrenia, EOS). Other individuals may not reach such clinically overt diagnostic threshold but nonetheless present Childhood Schizotypal Disorder (CSD) or a Clinical High-Risk for Psychosis (CHRP). While EOS is clinically more similar to the canonical adult-onset presentation, the other 3 subgroups (i.e. VEOS, CSD, CHRP) present more nuances and specific clinical characteristics, which require ad-hoc developmental and phenomenological considerations for appropriate differential diagnosis and prognosis. Therefore, current scoping review intends to saturate such knowledge gap with respect to early SSD-phenotypes.
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Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Andrea Raballo
- Chair of Psychiatry, Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland; Public Health Division, Department of Health and Social Care, Cantonal Socio-Psychiatric Organization, Repubblica e Cantone Ticino, Mendrisio, Switzerland
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Poletti M, Pelizza L, Preti A, Raballo A. Clinical High-Risk for Psychosis (CHR-P) circa 2024: Synoptic analysis and synthesis of contemporary treatment guidelines. Asian J Psychiatr 2024; 100:104142. [PMID: 39083954 DOI: 10.1016/j.ajp.2024.104142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/05/2024] [Accepted: 06/26/2024] [Indexed: 08/02/2024]
Abstract
The construct of Clinical-High Risk for Psychosis (CHR-P) identifies young help-seeking subjects in putative prodromal stages of psychosis and is a central component of the Early Intervention (EI) paradigm in Mental Health, aimed at facilitating rapid entry into appropriate care pathways to prevent the onset of psychosis or mitigate is biopsychosocial consequences. This approach, which promotes an innovative culture of care for early, at risk situations, is inspired by a clinical staging concept as a guide to optimal treatment. The objective of this article is to map the existing guidelines in the field of CHR-P treatment recommendations, examine overlaps and differences, and critically evaluate blind spots to be addressed in future guideline updated. The search identified 9 guidelines focused on CHR-P or schizophrenia and other psychotic conditions but containing a specific section on CHR-P or prodromal psychosis. All guidelines acknowledge that psychosis is preceded by more or less pronounced prodromal stages, and most detail CHR-P criteria. Among guidelines, 8 out of 9 indicate cognitive-behavioural therapy as the best psychotherapeutic option and 7 out of 9 suggest that antipsychotics can be prescribed as second option in case psychosocial and/or other pharmacological interventions prove insufficient or inadequate in reducing clinical severity and subjective suffering. Antidepressants, mood stabilizers, and benzodiazepines were considered for the treatment of comorbid disorders. Only the European Psychiatric Association Guidance paper distinguished treatment recommendations for adults and minors. Agreements in treatment guidelines were discussed in light of recent meta-analytical evidences on pharmacological and non-pharmacological treatments for CHR-P, suggesting the need to provide an updated, age-sensitive consensus on how to manage CHR-P individuals.
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Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, Università di Bologna, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Andrea Raballo
- Chair of Psychiatry, Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland; Cantonal Sociopsychiatric Organisation, Mendrisio, Switzerland.
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Poletti M, Raballo A. Ontogenesis of self-disorders in the schizophrenia spectrum: A phenomenological neuro-developmental model. Schizophr Res 2024; 272:26-35. [PMID: 39181008 DOI: 10.1016/j.schres.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/28/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
The concept of basic Self-disorders (SD) captures the experiential aspects associated with vulnerability to schizophrenia spectrum disorders (SSD). SD emerge prior to, and constitute the underlying structure for, the emergence of major diagnostic symptoms, including positive psychotic ones. SD are also detectable in populations with familial risk for SSD. This paper proposes a two-stage phenomenological-developmental model, exploring the early deficit in multisensory integration and their impact on the ontogeny of the Minimal Self in the first years of life. It also examines subsequent emergence of schizotaxic vulnerability, which later manifests as typical anomalies of subjectivity, such as basic symptoms and self-disorders.
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Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Raballo
- Chair of Psychiatry, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Cantonal Sociopsychiatric Organisation, Public Health Division, Department of Health and Social Care, Repubblica e Cantone Ticino, Mendrisio, Switzerland.
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Cheng KY, Robinson N, Ploner A, Kuja-Halkola R, Molero Y, Lichtenstein P, Bergen SE. Impact of traumatic brain injury on risk for schizophrenia and bipolar disorder. Psychiatry Res 2024; 339:115990. [PMID: 38896929 PMCID: PMC11321911 DOI: 10.1016/j.psychres.2024.115990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024]
Abstract
The impact of traumatic brain injury (TBI) on subsequent risk of schizophrenia (SCZ) or bipolar disorder (BD) remains contested. Possible genetic and environmental confounding effects have also been understudied. Therefore, we aim to investigate the impact of TBI on the risk of SCZ and BD and whether the effect varies by injury severity, age at injury, and sex. We identified 4,184 SCZ and 18,681 BD cases born between 1973 and 1998 in the Swedish National Registers. Case-control samples matched (1:5) on birth year, sex, and birthplace were created along with a family design study, with cases matched to non-case full siblings. TBI was associated with higher risk of SCZ and BD (IRR=1.33 for SCZ, IRR=1.78 for BD). The association remained significant in the sibling comparison study. Moderate or severe TBI was associated with higher risk for both SCZ and BD compared to mild TBI. Older age at injury was associated with higher risk of SCZ and BD, and the effect of TBI was stronger in women than men. Findings indicate that TBI is a risk factor for both SCZ and BD with differential impact by age, severity and sex and that this association cannot be explained by familial confounding alone.
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Affiliation(s)
- Kai-Yuan Cheng
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-17177 Stockholm, Sweden
| | - Natassia Robinson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-17177 Stockholm, Sweden
| | - Alexander Ploner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-17177 Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-17177 Stockholm, Sweden
| | - Yasmina Molero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-17177 Stockholm, Sweden; Centre for Psychiatric Research, Karolinska Institutet, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-17177 Stockholm, Sweden
| | - Sarah E Bergen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-17177 Stockholm, Sweden.
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Pelizza L, Plazzi E, Leuci E, Leucci AC, Quattrone E, Azzali S, Pupo S, Paulillo G, Pellegrini P, Menchetti M. Diagnostic shift in adolescents with first episode psychosis: findings from the 2-year follow-up of the "Parma Early Psychosis" program. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02721-2. [PMID: 38951155 DOI: 10.1007/s00127-024-02721-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 06/24/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE Diagnostic stability for people with First Episode Psychosis (FEP) is essential for treatment, but it remains poorly investigated, especially in adolescents and within a prospective design. The aims of this research were: (a) to examine diagnostic change in Italian adolescents with FEP treated within an "Early Intervention in Psychosis" program during a 2-year follow-up period and (b) to investigate any sociodemographic and clinical predictors at baseline. METHODS At baseline, 66 adolescents with FEP was recruited. Their primary diagnosis was formulated both at baseline and at the end of follow-up. At presentation, FEP adolescents completed the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). As for diagnostic stability, the Kappa statistic was calculated. The associations of diagnostic change with baseline clinical and sociodemographic features were analyzed using a logistic model with the diagnostic shift as dependent variable. A propensity score was finally calculated based on logistic analysis results. RESULTS 38 (57.6%) FEP adolescents changed their opening diagnosis. The highest prospective diagnostic stability was for initial diagnosis of schizophrenia (95.4%) and affective spectrum psychoses (75%). Diagnostic instability was high for opening diagnosis of psychosis not otherwise specified, brief psychosis and schizophreniform disorder (100%). The best predictors of diagnostic change were fewer years of education, shorter duration of untreated psychosis and higher baseline levels of psychiatric symptoms. CONCLUSION Diagnostic stability is crucial for treatment and clinical decision making. Addressing instability in FEP diagnoses is an important challenge for future diagnostic development in early psychosis, especially in adolescence.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum Università di Bologna, viale Pepoli 5, Bologna (BO), 40123, Italy.
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, largo Palli 1/a, Parma (PR), 43100, Italy.
| | - Enrico Plazzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum Università di Bologna, viale Pepoli 5, Bologna (BO), 40123, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, largo Palli 1/a, Parma (PR), 43100, Italy
| | - Anna Caterina Leucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum Università di Bologna, viale Pepoli 5, Bologna (BO), 40123, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, largo Palli 1/a, Parma (PR), 43100, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, viale Amendola 2, Reggio Emilia (RE), 42100, Italy
| | - Simona Pupo
- Pain Therapy Service, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, viale Gramsci 14, Parma (PR), 43100, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, largo Palli 1/a, Parma (PR), 43100, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, largo Palli 1/a, Parma (PR), 43100, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum Università di Bologna, viale Pepoli 5, Bologna (BO), 40123, Italy
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Raballo A, Poletti M, Preti A. Clinical High Risk for Psychosis (CHR-P) in children and adolescents: a roadmap to strengthen clinical utility through conceptual clarity. Eur Child Adolesc Psychiatry 2024; 33:1997-1999. [PMID: 36625988 DOI: 10.1007/s00787-023-02139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Affiliation(s)
- Andrea Raballo
- Public Health Division, Department of Health and Social Care, Cantonal Socio-Psychiatric Organization (OSC), Repubblica e Cantone Ticino, Mendrisio, Switzerland
- Psychiatry and Psychotherapy, Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Michele Poletti
- Child and Adolescent Neuropsychiatry Service, Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, 42122 Via Amendola 2, Reggio Emilia, Italy.
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
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Raballo A, Poletti M, Preti A. PSYCHS: Bridging Positive Symptoms and Diagnostic Criteria for Clinical High Risk for Psychosis-A litmus test for the field. Early Interv Psychiatry 2024; 18:275-277. [PMID: 38586961 DOI: 10.1111/eip.13474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/16/2023] [Accepted: 11/19/2023] [Indexed: 04/09/2024]
Affiliation(s)
- Andrea Raballo
- Chair of Psychiatry, Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
- Cantonal Sociopsychiatric Organisation, Mendrisio, Switzerland
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
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Poletti M, Preti A, Raballo A. Debate: The prevention of psychosis in child and adolescent mental health services. Child Adolesc Ment Health 2024; 29:107-109. [PMID: 38031312 DOI: 10.1111/camh.12685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
Psychopathological conditions in adolescence and young adulthood often result from an altered neurodevelopment already phenotypically expressed in childhood. Child and adolescent mental health services are ideally placed to intercept in the developmental trajectories of younger adolescents and contribute to the early detection of a risk for psychosis, as proposed by Salazar de Pablo and Arango (2023, Child and Adolescent Mental Health), opening a debate to which we contribute. The early detection of a specific risk for psychosis and of a broader risk for severe mental illness requires an understanding of the clinical staging of psychosis, neurodevelopmental antecedents of severe mental illness and of heterotypic trajectories between childhood phenotypes and adult disorders.
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Affiliation(s)
- Michele Poletti
- Child and Adolescent Neuropsychiatry Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Andrea Raballo
- Chair of Psychiatry, Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
- Cantonal Sociopsychiatric Organisation, Mendrisio, Switzerland
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Melillo A, Caporusso E, Giordano GM, Giuliani L, Pezzella P, Perrottelli A, Bucci P, Mucci A, Galderisi S. Correlations between Negative Symptoms and Cognitive Deficits in Individuals at First Psychotic Episode or at High Risk of Psychosis: A Systematic Review. J Clin Med 2023; 12:7095. [PMID: 38002707 PMCID: PMC10672428 DOI: 10.3390/jcm12227095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
The present review aims to identify correlations between negative symptoms (NS) and deficits in neurocognition and social cognition in subjects with first-episode psychosis (FEP) and at-high-risk populations (HR). A systematic search of the literature published between 1 January 2005 and 31 December 2022 was conducted on PubMed, Scopus, and PsycInfo. Out of the 4599 records identified, a total of 32 studies met our inclusion/exclusion criteria. Data on a total of 3086 FEP and 1732 HR were collected. The available evidence shows that NS correlate with executive functioning and theory of mind deficits in FEP subjects, and with deficits in the processing speed, attention and vigilance, and working memory in HR subjects. Visual learning and memory do not correlate with NS in either FEP or HR subjects. More inconsistent findings were retrieved in relation to other cognitive domains in both samples. The available evidence is limited by sample and methodological heterogeneity across studies and was rated as poor or average quality for the majority of included studies in both FEP and CHR populations. Further research based on shared definitions of first-episode psychosis and at-risk states, as well as on more recent conceptualizations of negative symptoms and cognitive impairment, is highly needed.
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Affiliation(s)
| | | | - Giulia Maria Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie, 80138 Naples, Italy
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Vanes LD, Murray RM, Nosarti C. Adult outcome of preterm birth: Implications for neurodevelopmental theories of psychosis. Schizophr Res 2022; 247:41-54. [PMID: 34006427 DOI: 10.1016/j.schres.2021.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022]
Abstract
Preterm birth is associated with an elevated risk of developmental and adult psychiatric disorders, including psychosis. In this review, we evaluate the implications of neurodevelopmental, cognitive, motor, and social sequelae of preterm birth for developing psychosis, with an emphasis on outcomes observed in adulthood. Abnormal brain development precipitated by early exposure to the extra-uterine environment, and exacerbated by neuroinflammation, neonatal brain injury, and genetic vulnerability, can result in alterations of brain structure and function persisting into adulthood. These alterations, including abnormal regional brain volumes and white matter macro- and micro-structure, can critically impair functional (e.g. frontoparietal and thalamocortical) network connectivity in a manner characteristic of psychotic illness. The resulting executive, social, and motor dysfunctions may constitute the basis for behavioural vulnerability ultimately giving rise to psychotic symptomatology. There are many pathways to psychosis, but elucidating more precisely the mechanisms whereby preterm birth increases risk may shed light on that route consequent upon early neurodevelopmental insult.
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Affiliation(s)
- Lucy D Vanes
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, King's College London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, King's College London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Poletti M, Preti A, Raballo A. Eating Disorders and Psychosis as Intertwined Dimensions of Disembodiment: A Narrative Review. CLINICAL NEUROPSYCHIATRY 2022; 19:187-192. [PMID: 35821871 PMCID: PMC9263683 DOI: 10.36131/cnfioritieditore20220307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although psychosis is not one of the most commonly recognized psychiatric comorbidities of Eating Disorders (ED), there is an increasing empirical evidence of associations between these psychopathological conditions. Indeed, ED as well as early manifestations of schizophrenic psychosis emerge during developmental years and might present some affinities in the presentation at onset. For example, adolescents with anorexia nervosa (AN) may report psychotic-like eating-related symptoms such as delusional-like body image distortions and/or "anorexic voice". Conversely, early expressions of schizophrenia spectrum vulnerability might involve altered bodily experiences, delusional ideation on food and eating as well as pseudo-anorectic behaviors. From a phenomenological perspective, this partial symptomatic overlap may lie on common features of disturbed corporeality in terms of disembodiment, although these alterations of embodiment are presumably rooted in distinct pathogenetic pathways (e.g., primary childhood ontogenetic pathway in schizophrenia vs. a secondary adolescent ontogenetic pathway in AN). A clinical-phenomenological attitude could be important not only to better discern potential overlaps and affinities between the two conditions, but also to better conceptualize and treat those background alterations of the embodied self. In particular, a phenomenological exploration of the experiential side of eating-related behaviors could be a decisive step to support early differential diagnosis and treatment appropriateness.
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Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Child and Adolescent Mental Health Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy,Corresponding author Michele Poletti Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy, phone +39052233550 E-mail:
| | | | - Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy,Center for Translational, Phenomenological and Developmental Psychopathology
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Raballo A, Poletti M. Towards a phenomenological and developmental clinical staging of the mind with psychosis. Lancet Psychiatry 2021; 8:277-278. [PMID: 33743878 DOI: 10.1016/s2215-0366(21)00075-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine and Surgery, University of Perugia, Perugia 06132, Italy; Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy.
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Early intervention in psychiatry through a developmental perspective. NPJ SCHIZOPHRENIA 2021; 7:8. [PMID: 33580020 PMCID: PMC7881202 DOI: 10.1038/s41537-021-00137-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/12/2021] [Indexed: 01/07/2023]
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Raballo A, Poletti M, Preti A, Parnas J. The Self in the Spectrum: A Meta-analysis of the Evidence Linking Basic Self-Disorders and Schizophrenia. Schizophr Bull 2021; 47:1007-1017. [PMID: 33479736 PMCID: PMC8266610 DOI: 10.1093/schbul/sbaa201] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Disturbed self-experience has been reported as a characteristic feature of schizophrenia since the first formulation of its diagnostic concept; however, only in the last 2 decades an explicit notion of basic Self-disturbance, or Self-Disorders (SD), has emerged as target for a systematic research program. We conducted systematic searches in bibliographical databases to identify cross-sectional studies that explored SD across different diagnostic groups and explored diagnostic ascription within or outside schizophrenia spectrum disorders (SSD) as main outcome. Data were pooled using fixed- and random-effects meta-analysis models. Heterogeneity was assessed using stratified meta-analyses and meta-regression. Of 218 identified studies, 32 were included in the systematic review and 27 in the meta-analysis. Patients diagnosed with SSD scored higher on measures of SD than healthy controls (HC) (Hedges' g = 1.8; 95% CI = 1.5 to 2.0), individuals diagnosed with other mental illness (OMI) (1.9; 1.6 to 2.2), bipolar or affective disorders (1.8; 1.4 to 2.2), and clinical high risk for psychosis (CHR) (1.6; 0.9 to 2.4). Patients with schizotypy or schizotypal personality disorder scored higher on measures of SD than OMI (1.5; 1.3 to 1.8) and HC (1.4; 1.1 to 1.7). Patients with first-episode psychosis scored higher on measures of SD than HC (2.5; 2.1 to 2.9) and OMI (1.6; 1.2 to 2.1). Subjects at CHR scored higher on measures of SD than HC (2.0; 1.7 to 2.2) and OMI (19; 1.6 to 2.2). Overall, heterogeneity ranged from negligible to high, especially in comparisons of the target group with OMI, probably as a reflection of the immanent diagnostic heterogeneity of this group. The findings suggest that SD selectively aggregate within schizophrenia spectrum disorders as compared to other mental disorders and that they could be a central phenotypic marker of vulnerability to schizophrenia across the different shades of severity of its spectrum of disorders.
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Affiliation(s)
- Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy,Center for Translational, Phenomenological and Developmental Psychopathology (CTPDP), Perugia University Hospital, Perugia, Italy,To whom correspondence should be addressed; Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia Piazzale Lucio Severi 1, 06132, Perugia, Italy; tel: +39 075 5783194, fax: +39 075 5783183, e-mail:
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Josef Parnas
- Center for Subjectivity Research, University of Copenhagen, 2300, Copenhagen, Denmark,Mental Health Centre Glostrup, University Hospital of Copenhagen, 2605, Brøndby, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen, Denmark
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Abstract
PURPOSE OF REVIEW Childhood and adolescence are a crucial time window for the early identification of perspectival risk for adult psychopathology. This article reviews current advances in the field. RECENT FINDINGS Converging developmentally focused and predictive approaches are rapidly expanding in the field of early identification of children and adolescents at risk for psychiatric illness. Although the former emphasizes early phenotypic trajectories emerging in childhood and adolescence, the latter operate in terms of clinical risk staging. Decisive advances in the field include the metaanalytical evidence of the predictive value of clinical high-risk criteria in childhood-adolescence; the systematization of premorbid manifestations of psychotic vulnerability and bipolar prodromes; the corroboration of certain sets of anomalous subjective experiences as transdiagnostic index of familial genetic risk (i.e., basic symptoms) and early developmental expression of schizophrenia spectrum vulnerability (i.e., self-disorders). SUMMARY Childhood phenotypic manifestations of liability to mental disorders are often cooccurrent and undergo a plastic, heterotypic modification along the transition to adolescence. In general, they represent epiphenomenic flags of a broad vulnerability for the subsequent structuration of mental illness. This perspective coheres with the p-factor model of psychopathology and complements the clinical staging model which informs the early detection paradigm of severe mental disorders.
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Poletti M, Raballo A. Childhood schizotypal features vs. high-functioning autism spectrum disorder: Developmental overlaps and phenomenological differences. Schizophr Res 2020; 223:53-58. [PMID: 33046336 DOI: 10.1016/j.schres.2020.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/18/2020] [Accepted: 09/26/2020] [Indexed: 12/27/2022]
Abstract
Although autism spectrum disorder and schizophrenia have allegedly different onset timelines (e.g. in early years of life vs adolescence/early adulthood), there is nonetheless a diagnostic grey-zone along developmental stages, in which overlapping clinical features related to social impairment and oddity could impact on the differential diagnosis between childhood schizotypal features and high-functioning autism spectrum disorder. A phenomenological perspective may be helpful for the purpose of timely differential diagnosis also in developmental years.
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Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy
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Poletti M, Gebhardt E, Pelizza L, Preti A, Raballo A. Looking at Intergenerational Risk Factors in Schizophrenia Spectrum Disorders: New Frontiers for Early Vulnerability Identification? Front Psychiatry 2020; 11:566683. [PMID: 33192689 PMCID: PMC7649773 DOI: 10.3389/fpsyt.2020.566683] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/22/2020] [Indexed: 12/02/2022] Open
Abstract
Offspring of individuals with serious mental illness (SMI) constitute a special population with a higher risk of developing psychiatric disorders, which is also highly prevalent among referrals to child and adolescent mental health services (CAMHS). They often exhibit more or less subclinical conditions of vulnerability, fueled by mutually potentiating combinations of risk factors, such as presumed genetic risk, poor or inadequate affective and cognitive parenting, and low socio-economic status. Despite this evidence, neither specific preventive programs for offspring of parents with SMI are usually implemented in CAMHS, nor dedicated supportive programs for parenting are generally available in adult mental health services (AMHS). Needless to say, while both service systems tend to focus on individual recovery and clinical management (rather than on the whole family system), these blind spots add up to frequent gaps in communication and continuity of care between CAMHS and AMHS. This is particularly problematic in an age-range in which an offspring's vulnerabilities encounter the highest epidemiological peak of incident risk of SMI. This paper offers a clinical-conceptual perspective aimed to disentangle the complex intertwine of intergenerational risk factors that contribute to the risk of developing SMI in offspring, taking schizophrenia spectrum disorders as a paradigmatic example.
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Affiliation(s)
- Michele Poletti
- Child and Adolescent Neuropsychiatry Unit, Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Eva Gebhardt
- Department of Mental Health, ASL Roma 4, Civitavecchia, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
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