Psychosis prevention: early diagnosis and basic symptoms

The idea of ​​studying the debut of a serious and disabling disease like psychosis in order to be able to prevent it has always been present on the mental health scene.

Numerous authors have strongly supported the need to Do not underestimate the signs and symptoms (mostly) Subscription that would allow to intervene before the disease manifests itself.

Although the question appears so significant, the extreme non -specific symptoms and so -called “prodromal” signs (the first indicators of the future pathology), makes the realization of really applicable and effective preventive plans (of Caesar, 2018).

No less, integrating the treatment perspective with primary prevention optics requires a great change in the way of framing these patients (reflecting again on the causes of psychosis, on its insidious methods of onset, development, maintenance, on possible treatments and on the professionals/services involved or to be involved …).

The first effort that would be necessary to adopt such a perspective requires to shift attention to all those factors that, without still constituting themselves, represent “Risk catalyst” elements (Huber, 1966; Huber and Gross, 1989; Gross, 1989; Gross & Huber, 2005).

We try to go into this complexity by explaining some essential concepts.

Duration of untreated psychosis (DUP)

The acronym DUP (duration of the untreated psychosis) indicates the time between the first appearance of the symptoms/signs of illness and the first request for help; He stands On average over two years.

The more the duration of the untreated psychosis, the greater the resistance to the treatment, the longer the time necessary to reach the remission and the greater also the symptomatological gravity that will be determined.

You understand how the systematic reduction of the DUPtherefore, is constituted as a fundamental step of a preventive nature. How could we achieve such an outcome?

1. By affecting all the cultural and social factors – first of all the stigma connected to the idea of ​​having a psychic disorder – which delay access to the request for care;
2. By increasing the accessibility of mental health services, keeping in mind all the symptoms and signs that are constituted as “alarm bells” (prodromes, mental states at risk).

Difficulties and risks in early diagnosis

Not a small issues, if we think about how it can be really difficult, in the presence of non -clinically defined paintings, establish if and how to intervene!

There prodromal phase In fact, it represents an indefinite diagnostic entity, which also concerns teenage subjects.

How can we learn to distinguish those who, presenting a mental state at risk, will evolve into a psychotic disorder from those who, fortunately, will not do it?

In fact, there is also the risk, not a small, of an unnecessary intervention that implies powerful stigmatization effects (Cocchi & Meneghelli, 2012).

A mistake to avoid at all costs! In this sense, they help us all those studies that have dealt with studying the passages (often nuanced) who lead to a psychotic debut, which we see summarizes below.

The three phases that precede the psychotic debut

The research documented that a conclated episode of psychosis (the first that manifests itself is defined as “debut”) is generally preceded by a prodromal period of various duration, during which the subject experiences a substantial change in self -experience and the World (Schultze-Lutter et al., 2007). This is divided into a crescendo grossly represented in the three phases that follow (Cocchi & Meneghelli, 2012).

• In the first phase We find an increase in emotional tension: the surrounding environment, one’s thoughts, one’s actions, one’s body seem to be different and the experiences of depersonalization, perplexity and derealization (non -specific symptoms) seem to be recruive.
• In the second phase The first explanatory attempts necessary to cushion the arousal described in the first phase are manifested: the anomalous and disturbing sensations, the feeling that the thoughts, the body, the will are foreign and that the surrounding world is less authentic, are attributed to action of external agents (still not well defined). These are still not frankly psychotic symptoms but that begin to turn towards this greater form of alteration (attenuated symptoms).
• In the third phase Finally, the certainty is established on how, because and whoever mitigates these manipulations (Cocchi, Meneghelli, 2012). The structuring of delusional beliefs begins to regulate the emotional tension of the previous stages. The first francs psychotic symptoms appear.

We understand how, in a preventive perspective, to become able to intercept the symptoms and signs attributable to the “phase one” becomes an ambitious but essential goal.

Let’s see below the contribution of some authors who have tried to reflect on these aspects.

Predictive signs and symptoms to be attentive

On the basis of the reflection summarized so far, Schultze-Lutter and Koch have developed an assessment tool aimed at the measure of the risk to be able to develop a psychotic disorder, then dedicating themselves to the drafting of a new version aimed at children and adolescents (Schultze-Lutter, Koch , 2009).

There Schizophrenia pronense instruents, Child and Youth Version (SPI-CY) It is an interview that aims to explore four fundamental areas that group the main signs and symptoms that could manifest themselves in the phases preceding the psychotic debut, diversified in nonmacific and specific.

The four symptomatological areas that form the interview and some example of the symptoms investigated are listed below:

1. Adynamia (with various subcomponents including: reduction of strength and energy, constancy and patience, motivation and psychic tolerance to stress, reduction of interest in the outside world, periodic lowering of mood, increased impressability … );
2. Perception disorders (with various subcomponents including: reduced ability to discriminate between images and perceptions, tendency to self -referentiality, alteration of visual perception, acoustic hypersensitivity, derealization, proprioceptive disorders …);
3. Neuroticism (with various subcomponents including: decrease in the need for social relationship, impressability with respect to the suffering of others, increased reactivity, phobias …);
4. Disturbes of thought and mood (with various subcomponents such as: reduction of decision -making capacity, memory disorders, symbolic understanding disorder, expressive language disorder, motor bloc …).

Two groups of criteria were then identified, respectively defined as cognitive-perceptive basic symptoms (covers) and High Risk Criterion, cognitive disorders (Cogdis), which must be investigated not only with respect to the simple presence, but also compared to duration and pervasiveness. They have a high predictive index.

A fundamental step in the prevention of psychosis: diagnostic evaluation

The precious contribution of the aforementioned authors, which has allowed the finalization of the tool described, appears to be a clear example of how we can act in a preventive perspective thinking about the theme of psychosis.

THE Basic symptomsmasterfully identified and operationalized, they become essential elements in identifying prodromal symptoms.

In addition, the structure in the form of an interview allows the (young) patient to experience the experience of the evaluation as the first element of support and real expression of availability and welcome. This in a moment in which, it is understood well, it is even more essential to feel understood in one’s experience.

It is also evident that the first Questions related to basic symptomsbetter prepare the soil to deal with the topic of the classic psychotic symptoms (such as hallucinations and delusions), creating a first therapeutic alliance.

Conclusions

In conclusion, the importance of Basic symptoms for the diagnosis of psychosis It is undeniable.

An early recognition of the symptomatology cannot be separated from a re -adaptation of the tools in our possession to the peculiarities of the adolescent development of the criteria provided for adults.

THE’early diagnostic interventionaccurate and scientifically oriented is a valid example of how you can act concretely in the direction of effective prevention.

Bibliography

• Cocchi, A., Meneghelli, A. (2012) The early intervention between practice and research. Turin: 2004 Editor Scientific Center.
• By Cesare, G. (2018) Psychotic debut or evolutionary block. A difficult dilemma. Psychobody 1/2018, pp 32-48.
• Gross, G. (1989) The “Basic” Sympoms of Schizophrenia. British Journal of Psychiatry7, Suppl, 21-25.
• Gross, G., Huber, G. (2005) Basic Syptoms and Prodromal Phase of Schizophrenia. Neurological Psychiatry Brain Research12, 185-198.
• Ruhrmann, S., Schultze-Lutter, F., Klosterköter, J. (2010) Probably AT-RISK, But Certainly Ill-Advocating the Introduction of a Psychosis Spectrum Disorder in DSM-V. Schizophrenia Research; 120: 23-37.
• Schultze-Lutter, F. (2009) Subjective Syptoms of Schizophrenia in Research and in the Clinic: The Basic Syptoms Concept. Schizophrenia Bullettin. 35, 1, 5-8.
• Schultze-Lutter, F., Koch, E. (2010) Schizophrenia pronense instruent, Child and Youth Version (SPI-CY). Rome, Giovanni Fioriti Editore.
• Schultze-Lutter, F., Ruhrmann, S., Klosterköter, J. (2006) Can Schizophrenia be predicted Phenomenologically? In: Johannesssen Jo, Martindale B, Cullberg J. Editors. Evolving Psychosis. Different Stages, Different Treatments. London, New York: Routledge, p. 104-23.
• Schultze-Lutter, F., Koch, E. (2009). Schizophrenia pronense instruent, Child and Youth Version (SPI-CY). (Trad.it.: Evaluation tool for the propensity to schizophrenia-version for children and teenagers (SPI-cy), Rome: Giovanni Fioriti Editore, 2010).