Psychosis Not Only Factor to Treat for Adolescents at High Risk for Schizophrenia

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Ricardo Carrión, Ph.D.
Ricardo Carrión, Ph.D.

With the aid of a NARSAD Grant, a new study of adolescents at high risk for developing psychosis found that their long-term functioning is not solely dependent on the progression or development of full-blown psychosis. The findings, published online September 4th in JAMA Psychiatry, show that regardless of psychosis “conversion” (early warning symptoms developing into full-blown psychosis), the at-risk adolescents were at higher risk for poor functional outcomes, including impaired cognition, lack of social support and an inability to function independently in the community.

Led by NARSAD Young Investigator Grantee, Ricardo Carrión, Ph.D., of the Zucker Hillside Hospital in Glen Oaks, New York, researchers examined 92 teens who showed early warning signs of psychosis (such as delusional ideas or social difficulties) that are troubling, but aren’t strong enough to meet the criteria for a diagnosis of a psychotic disorder (such as schizophrenia or bipolar disorder). The adolescents (average age 16 years) were followed up for an average of three years. Fifteen developed psychosis, and had generally poor outcomes, with 86.7 percent and 66.7 percent having poor social and role outcomes, respectively. However, among the 77 who did not develop psychosis, there were also poor social and role outcomes with corresponding rates of 40.3 percent and 45.5 percent, respectively.

The researchers found that neurocognitive performance and functioning level at baseline (relative to 68 mentally healthy controls) were also predictors of functional outcomes, independent of the development of psychosis. “Our results demonstrate that a preventive approach to psychosis should be extended to include relevant functional outcomes, because these markers provided relevant discrimination between individuals with poor and good outcomes,” Dr. Carrión et. al. write in JAMA Psychiatry.

“These adolescents and young adults are both at risk for psychosis and functional disability,” say the researchers. “Thus, prevention is needed for emerging psychosis, as well as for helping these individuals cope with persistent relationship and school/work difficulties.”

Read more about this research.

Read the abstract for this study.

Article comments

Absolutely quite agree with this research. Early warning signs as described above in this article, were apparent in our son (such as delusional ideas or social difficulties particularly in his latter teen years), but remarkably these traits were not consistent (erratic) including his cognitive performance. He confused his teachers as he could out-perform the average students in one semester and then collapse the next one..... he himself was confused about his performance and abilities leading him to get very frustrated and increasing his inner -stress. His inconsistency was interpreted by some teachers as an attitude problem, yet we knew at home he was struggling and really trying his very best. We sought professional assessment with a clinical/educational psychologist (tested his cognitive abilities) only to prove that he was well above average thus fooling the assessor, and everyone else including himself, and then only later to loose his ability to function in full. Hence,without a proper diagnosis, he never received any educational support or even empathy leaving him in a stressful situation and eventually leading to full mental breakdown-psychosis. However, in our son's case he was always very social, highly sensitive and caring to others.....he difficulty dealing with more aggressive individuals-bullies in school. early diagnosis and a correct one might have alleviated his stress, hence avoiding the final blow of psychosis or permanent illness.

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Please note that researchers cannot give specific recommendations or advice about treatment; diagnosis and treatment are complex and highly individualized processes that require comprehensive face-to- face assessment. Please visit our "Ask an Expert" section to see a list of Q & A with NARSAD Grantees.
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