Research Topic

Psychosis and Personality Disorders: Do We Need Early Diagnosis for Successful Treatment?

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Early diagnosis is one of the most relevant and interesting issues of modern clinical psychiatry. Several investigations pointed out the need to detect the prodromal signs and symptoms of psychiatric diseases to define and implement specific monitoring and early interventions strategies. In particular, the ...

Early diagnosis is one of the most relevant and interesting issues of modern clinical psychiatry. Several investigations pointed out the need to detect the prodromal signs and symptoms of psychiatric diseases to define and implement specific monitoring and early interventions strategies. In particular, the available evidences show that the lack of diagnosis and treatment in the early periods of disorders that present their onset in adolescence or young adulthood and induce a high level of disability, such as schizophrenia spectrum disorders (SSDs) and severe personality disorders (PDs), are related to a worse illness course with more frequent relapses and risk of chronicity.

Many patients who suffer from psychosis display a long duration of untreated illness with significant negative consequences for the psychosocial functioning, subsequent response to treatments, remission of symptoms and recovery. Moreover, at the first contact with medical care most patients present multiple risk factors to develop psychosis, such as positive family history for psychosis, pregnancy or birth complications, early developmental disorders, early traumatic events, early and intensive substance use, and mental disorders predisposing to the onset of psychosis. A careful search for detection of these factors would be extremely important for prevention and prompt therapeutic intervention.

In a similar way, although severe PDs, in particular borderline personality disorder (BPD), are known to have their onset in young age, often in adolescence, its diagnosis and treatment is usually delayed. So, investigations aimed to enhance the ability of finding out symptoms at the earliest stages of illness have to be encouraged. It is also of fundamental importance to identify clinical conditions of childhood that can evolve with high frequency in BPD, such as disruptive behaviour and disturbances in attention and emotional regulation, conduct disorders, oppositional defiant disorder, attention deficit - hyperactivity disorder, and substance use disorders.

In the past decades there was a lively debate to establish whether pharmacotherapy in the prodromal phases of psychiatric disorders is efficacious and ethically acceptable. Several investigations were performed on this topic, but final conclusions have not been drawn. On the contrary, it is commonly accepted that specific psychosocial interventions that involve not only patients, but also their family members produce positive results in terms of reduction of symptoms, comprehension of disorders and improvement of coping skills. These results can be particularly useful if we consider that, already during the first phases of monitoring and treatment, the risk of service disengagement and medication non-adherence is high and should be carefully faced as both these factors increase the probability of poor response, relapse and treatment resistance.

In this Research Topic we will include national and international contributions regarding onset, early signs and symptoms, and resistance to treatment of psychotic disorders and severe personality disorders. Our purpose is to highlight recent advances in the early diagnosis and treatment of these mental disorders and determine in which measure early interventions may impact illness course and prognosis.


Keywords: early onset, personality disorders, psychosis, diagnosis, treatment


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