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Front. Psychiatry | doi: 10.3389/fpsyt.2019.00787

Predictors of outcome and transition to psychosis in adolescents with severe psychiatric disorders: a longitudinal protocol study

 Silvia Molteni1,  Eleonora Filosi2,  Maria M. Mensi1, 2*,  Giulia Spada3,  Chiara Zandrini1, Federica Ferro2, Matteo Paoletti1, 2, Claudia Gandini1, 2, Anna Picchiecchio1, 2,  Ilaria Bonoldi1, 3 and  UMBERTO BALOTTIN1, 2
  • 1Department of Nervous System and Behavioral Sciences, University of Pavia, Italy
  • 2Neurological Institute Foundation Casimiro Mondino (IRCCS), Italy
  • 3Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom

In children and adolescents, schizophrenia is one of the ten main causes of disability-adjusted life years. The identification of people at Clinical High Risk of developing Psychosis (CHR-P) is one of the most promising strategies to improve outcomes. However, in children and adolescents research on the CHR-P state is still in its infancy and the clinical validity of at-risk criteria appears understudied in this population. Furthermore, only few studies have evaluated the psychopathological, neuropsychological, neuroimaging characteristics and, especially, long-term outcomes of adolescents at high risk.
We present here the protocol of an innovative longitudinal cohort study of adolescents aged 12-17. The sample will consist of patients admitted to a third level neuropsychiatric unit, belonging to one of the following three subgroups: 1. adolescents with established DSM 5 psychosis, 2. adolescents with CHR-P and 3. adolescents with psychiatric disorders other than established psychosis or CHR-P.
The primary aim of our study is to evaluate the 2-year prognosis across the three groups. We will measure transition to psychosis (or the stability of the diagnosis of psychosis in the psychotic group), the risk of development of other psychiatric disorders as well as socio-occupational functioning at outcome. The secondary aim will be to explore the effect of specific predictors (clinical, neuropsychological and neuroimaging factors) on the prognosis.
At baseline, 1-year and 2-year follow-up participants will be assessed using standardized semi-structured interviews and instruments. Psychopathological and functioning variables, as well as neuropsychological domains will be compared across the three subgroups. Moreover, at baseline and 2-year follow-up all recruited patients will undergo a 3 Tesla MRI examination and diffusion tensor imaging parameters will be analyzed.
We believe that this study will advance our ability to predict outcomes in underage CHR-P samples. In particular, our data will enable a better understanding of the clinical significance of CHR-P in adolescents, and shade new light on prognostic factors that can be used to refine the prediction of clinical outcomes and the implementation of preventive interventions.

Keywords: attenuated psychosis syndrome, Adolecence, Transition, functioning, Outcome, prognosis, CHR, Young people, psychosis

Received: 14 Dec 2018; Accepted: 02 Oct 2019.

Copyright: © 2019 Molteni, Filosi, Mensi, Spada, Zandrini, Ferro, Paoletti, Gandini, Picchiecchio, Bonoldi and BALOTTIN. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Maria M. Mensi, Department of Nervous System and Behavioral Sciences, University of Pavia, Pavia, 27100, Lombardy, Italy, martina.mensi@mondino.it