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Adolescent Psychosis: Clinical and Scientific Perspectives
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About the contributors
Chapter 1 Introduction to psychotic disorders in adolescence
Chapter 2 The epidemiology of early-onset psychosis
Chapter 3 Genetics of psychotic disorders with focus on early-onset psychosis
Chapter 4 Early risk factors in early-onset psychosis
Chapter 5 Adolescent psychosis and transdiagnostic delimitations to other clinical syndromes
Chapter 6 Cognitive functioning in early-onset psychosis
Chapter 7 The immunopsychiatry of early-onset psychosis
Chapter 8 Structural brain imaging in early-onset psychosis
Chapter 9 Functional brain imaging in early-onset psychosis
Chapter 10 Adolescence as a vulnerable period for psychosis development
Chapter 11 Current treatment options in early-onset psychosis
Chapter 12 Long-term development and outcome of early-onset psychosis
Chapter 13 Ethical considerations and current research practices in adolescent psychosis
1. Introduction to psychotic disorders in adolescence
Introduction
Clinical characteristics
Psychotic experiences
Symptom domains
Positive symptoms
Negative symptoms
Disorganized symptoms
Affective symptoms
Suicidal behavior
Diagnostic interviews
Schedule for affective disorders and schizophrenia for school-age children-present and Lifetime version (K-SADS-PL)
Structured clinical interview for DSM (SCID)
Mini-International Neuropsychiatric Interview (M.I.N.I.)
Comorbidity
Psychiatric comorbidity
Somatic comorbidity
The neurodevelopmental hypothesis of schizophrenia
Genetic and environmental influence
Clinical heterogeneity
Future directions
Developmental trajectories
Interdisciplinary studies
Experimental approaches
Clinical and societal responsibility
Ethical considerations
Conclusion
Acknowledgments
References
2. The epidemiology of early-onset psychosis
Introduction
The incidence and prevalence of adolescent psychosis
Population-based epidemiological studies
Studies from the Global South
Affective psychotic disorders
Sex differences
Diagnostic stability
Incidence and prevalence of psychotic symptoms in adolescence
Methodological considerations
Future directions
Conclusions
References
3. Genetics of psychotic disorders with focus on early-onset psychosis
Introduction
Genetic epidemiology
Family studies
Twin and adoption studies
Molecular genetics
Methods
Linkage studies
Candidate gene studies
Genome-wide association studies
Novel polygenic analytical approaches
Polygenic risk score (PRS)
Heritability estimations
Enrichment analysis
Copy number variants
Whole exome/genome sequencing
Pharmacogenetics and pharmacogenomics
Genetic architecture of early-onset psychosis
Common variants
Rare variants
Copy number variants in psychotic disorders
Imprinting disorders, epigenetics, and psychosis
Genetic overlap
From genetic loci to disease mechanisms
Clinical implications
Conclusion
Acknowledgments
References
4. Early risk factors in early-onset psychosis
Biological risk factors
Pre- and perinatal factors
Hypoxia
Infections
Nutrients
Cannabis use
Hormonal changes
Psychological risk factors
Clinical high-risk
Early childhood adversity
Emotion regulation
Hypothalamic-pituitary-adrenal (HPA) axis
Dopamine
Social risk factors
Social stress
Immigrant, racial and ethnic minority status
Conclusions
Clinical implications
Future directions
Acknowledgment
References
5. Adolescent psychosis and transdiagnostic delimitations to other clinical syndromes
Introduction
Prenatal and young life predictors of early-onset psychosis
ESSENCE
ESSENCE as a concept
Prevalence of ESSENCE
Attention-deficit/hyperactivity disorder
Autism spectrum disorder
Speech and language disorder
Developmental coordination disorder
Intellectual developmental disorder and borderline intellectual functioning
Tourette's disorder and other tic syndromes
Reactive attachment disorder and disinhibited social engagement disorder
Pediatric acute-onset neuropsychiatric disorder (PANS/PANDAS)
Behavioral phenotype syndromes and neurological disorders
Substance-induced psychosis
When should one suspect an ESSENCE disorder?
Outcome of ESSENCE
How to deal with ESSENCE specifically in the context of early-onset psychosis
Implications of further intervention/treatment approaches
Future directions
References
6. Cognitive functioning in early-onset psychosis
Introduction
Relevant cognitive domains
Processing speed
Learning and memory
Working memory
Attention
Executive functions
Social cognition
Intelligence quotient (IQ)
The neurobiology of cognition
Cognitive course
Sex differences in cognitive functioning
Cognition and symptoms
Cognition and functional outcome
Cognitive assessment
The Wechsler Intelligence Scales for children and adults
The MATRICS Consensus Cognitive Battery
Other cognitive batteries for schizophrenia
Clinical implications
Pharmacological treatment
Cognitive remediation
Psychoeducation
Future directions
Conclusion
Acknowledgments
References
7. The immunopsychiatry of early-onset psychosis
Introduction
The immune system and neurodevelopment
Immune system functions and brain physiology
Cytokines in CNS development, maintenance, and pathophysiology
Glial cells in CNS development, maintenance, and pathophysiology
Cytokines and glial cells in adults with psychotic disorders
The neurodevelopmental aspects of immune activation in psychosis
Clinical findings on immune system dysregulation in individuals with psychotic disorders
Immune-inflammatory markers in longitudinal studies of psychosis
Predictive value of immune-inflammatory markers in individuals with clinical high risk for psychosis
Immune-inflammatory markers in adolescents with early-onset psychosis
Relationships between immune-inflammatory markers and clinical phenotypes in individuals with early-onset psychosis
Scientific implications
Clinical implications
References
8. Structural brain imaging in early-onset psychosis
Introduction
Structural MRI methods
Subcortical and cortical morphometry
White matter microstructure and connectivity
Subcortical brain morphology
Intracranial-, subcortical, and cerebellar structure volumes
Subcortical structures in bipolar disorder
Cortical brain morphology
Altered cortical structures and development
Cortical structures in bipolar disorder
White matter microstructure and connectivity
White matter microstructure and connectivity in psychosis
White matter microstructure and connectivity in early-onset psychosis
White matter microstructure and connectivity in bipolar disorder
Relationships with symptom profiles and functioning
Impact of medication
Clinical implications
Future directions
Conclusion
References
9. Functional brain imaging in early-onset psychosis
Introduction
Systematic literature review
Task-related functional magnetic resonance imaging studies
Cognitive systems
Cognitive control: response selection, inhibition/suppression, performance monitoring
Cognitive control: updating, representation, and maintenance
Declarative memory
Working memory
Social processes
Social communication: reception of facial communication
Positive valence systems
Reward learning: probabilistic and reinforcement learning
Reward responsiveness
Sensorimotor systems: motor actions
Arousal and regulatory systems: arousal
Summary of t-fMRI findings
Resting-state functional magnetic resonance imaging studies
Resting-state connectome architecture and topology
MR regional homogeneity and amplitude
Resting-state networks
Seed-based resting-state connectivity
Amygdala
Thalamus
Cerebellum
Prefrontal regions
Interhemispheric connectivity
Summary of rs-fMRI findings
Conclusions and future directions
References
10. Adolescence as a vulnerable period for psychosis development
Introduction
Social behavior during adolescence
Social interactions can be rewarding and stressful
Hypothalamusβpituitaryβadrenal axis
Hypothalamusβpituitaryβgonadal axis
Interactions between the HPA and HPG axes
White matter during adolescence
Cerebral cortex during adolescence
Virtual histology
Brain response to faces: organizational and activational effects of testosterone
Conclusions and future directions
References
11. Current treatment options in early-onset psychosis
Introduction
General treatment principles
Antipsychotic treatment
Choice of medication
Side effects
Neuromotor
Metabolic
Cardiac
Endocrine
Autonomic
Sedative
Side effect monitoring
Genetic variation
Approved medications
Switching medication
Discontinuing medication
Antipsychotic medication and pregnancy
Pharmacological treatment of other psychiatric symptoms
Electroconvulsive therapy
Psychosocial treatment
Early Intervention Services
OPUS YOUNG
Cognitive-behavioral case management
Psychoeducational family-based intervention
Social cognition and interaction training
Cognitive-behavioral therapy
Prevention and treatment of substance abuse
Support to siblings
Support from peers
Transition to adult psychiatry or social services
Cognitive remediation therapy
Future directions
Conclusions
Acknowledgments
References
12. Long-term development and outcome of early-onset psychosis
Introduction
Sociodemographics
Labor market affiliation, education, and income
Children and cohabitation
Service use
Substance abuse
Mortality and suicidality
Medication
Cognition
Long-term prognosis
Clinical predictors of outcomes
Positive and negative symptoms
Recovery
Conclusion
Acknowledgments
References
13. Ethical considerations and current research practices in adolescent psychosis
Introduction
Ethical considerations in adolescent psychosis research
Early diagnosis and treatment
Genetic information
Brain maturation and its impact on cognitive and social skills development
Informed consent
Gray area in terms of informed consent
Stigma and self-stigma related to the diagnosis
Practical considerations in adolescent psychosis research
Communication
Focus groups
Representativity
Length of the research protocol, and adherence to longitudinal studies
Interview format
Data collection and sharing
Deidentification
Incidental findings
Future directions and conclusion
Acknowledgments
References
Index
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