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Early detection and specialised early intervention for people at high risk for psychotic disorders have received growing attention in the past few decades, with the aim of delaying or preventing the outbreak of explicit psychotic symptoms and improving functional outcomes. This article summarises criteria for a diagnosis of high psychosis risk, the implications for such a diagnosis and recommendations for treatment.
After reading this article you will be able to:
•recognise signs and symptoms indicating increased psychosis risk
•understand uses and limitations of screening for high psychosis risk, and interpretation of results
•recognise evidence-based treatment options for patients at clinical high risk for psychosis.
DECLARATION OF INTEREST
C.A. has received non-financial support from Sunovion and Lundbeck in the past 36 months.
In this issue, Falkenberg et al explore the practicability of magnetic resonance imaging (MRI) as part of the initial clinical assessment in patients with first-episode psychosis and the prevalence, nature and clinical significance of radiological abnormalities in these patients. They provide evidence for the use of MRI data to detect gross brain abnormalities. In addition, improvements in quantitative analyses makes MRI an indispensable tool to elucidate the neurobiological substrates that might underlie primary (or idiopathic) psychotic illness.
Pituitary enlargement has been reported in individuals with schizophrenic psychosis or an at-risk mental state for psychosis (ARMS). In a previous study, our group could show pituitary volume increase in first episode and ARMS patients with later transition to psychosis (ARMS-T). However, there are no longitudinal studies on this issue so far. We therefore examined longitudinally whether transition to psychosis would be accompanied by a further increase of pituitary volume in antipsychotic-naïve ARMS patients.
Magnetic resonance imaging (MRI) data were acquired from 23 antipsychotic-naïve individuals with an ARMS. Ten subjects developed psychosis (ARMS-T) and 13 did not (ARMS-NT). ARMS-T were re-scanned after the onset of psychosis, and ARMS-NT were re-scanned at the end of the study period.
There was no significant difference of the pituitary volume between ARMS-T and ARMS-NT in our sample, and there were no significant pituitary volume changes over time.
Longitudinally, we could not detect any further volumetric changes in the pituitary volume with transition to psychosis.
This, together with the result of our previous study, could indicate that the perceived level of stress in ARMS patients is constantly high from very early onward.
Psychiatric imaging needs to move away from simple investigations of the neurobiology underlying the early phases of schizophrenia to translate imaging findings in the clinical field, targeting clinical outcomes including transition, remission and response to preventive interventions.
Neuroanatomical abnormalities are a well-established feature of
schizophrenia. However, the timing of their emergence and the extent to
which they are related to vulnerability to the disorder as opposed to
psychotic illness itself is unclear
To assess regional grey matter volume in the at-risk individuals who
subsequently developed psychosis
Magnetic resonance imaging data from at-risk individuals who developed
psychosis (n = 12) within the following 25 months were
compared with data from healthy volunteers (n=22) and
people with first-episode psychosis (n=25)
Compared with healthy volunteers, individuals who subsequently developed
psychosis had smaller grey matter volume in the posterior cingulate
gyrus, precuneus, and paracentral lobule bilaterally and in the left
superior parietal lobule, and greater grey matter volume in a left
parietal/posterior temporal region. Compared with first-episode patients,
they had relatively greater grey matter volume in the temporal gyrus
bilaterally and smaller grey matter volume in the right lentiform
Some of the structural brain abnormalities in individuals with an at-risk
mental state may be related to an increased vulnerability to psychosis,
while others are associated with the development of a psychotic
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