English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Psychotic disorders, particularly of the schizophreniaspectrum, are among the most severe mental diseases. They can lead to delays in the maturation of neuropsychological functions in affected children and adolescents and longterm neuropsychological deficits [1, 2] as well as significant impairments in psychosocial functioning [3]. This makes schizophrenia one of the six leading causes of years lived with disability [4]. To fight the devastating consequences of psychotic disorders, two strategies have been followed with great enthusiasm and hope over the last 15 years. One strategy is to detect the disorder as early as possible, i.e., to reduce the duration of untreated psychosis and, consequently, to adequately treat the disorder as soon as possible with an early and specialized intervention. Notably, it was assumed for a long time that an adolescent onset of psychosis (before age 18, EOP) is associated with worse outcomes compared to adult-onset psychosis (AOP; [5]). However, two recent studies comparing EOP (age 14–17) with AOP (age 18–30) did not support this assumption. They indicated that EOP when also treated in an early psychosis, prevention and intervention centre have similar short-term [6] and similar or even better long-term outcomes [7]. Most recently, an independent comparative population based study conducted in a different centre confirmed these findings [8]. It still remains to be shown whether specialized early detection and intervention indeed causes the similar or even better outcomes of EOP. Despite the face validity of early intervention, it is not yet clear for patients with AOP that early intervention is superior to treatment-as-usual for patients with AOP. A recent Cochrane review concluded that there is some support for the superior effectiveness of early intervention, but that further studies are desirable, and that it is questionable whether gains are maintained [9]. Regarding early intervention strategies, it is generally recommended that an early intervention service should be provided longer than 2 years [10] or, alternatively, new strategies should be developed to produce more sustainable effects of short-term intensive early intervention programs. For children and adolescents with EOP, studies on the effectiveness of such programs or special needs within these programs are necessary. While initial evidence suggests that early intervention works in adolescents [7], the duration of untreated psychosis was found to be clearly longer in adolescents than in adults despite early detection efforts [11, 12]. However, the reasons for this are not known. Potential reasons are: insufficient knowledge about psychotic symptoms in the respective health care service (including child and adolescent psychiatry/psychology); a more insidious onset of symptoms; more negative symptoms; higher rates of refusal to seek help, and overlooking symptoms or misinterpreting them as adolescent crisis by parents and teachers. The second strategy to improve outcome of psychotic disorders is to detect early signs of the emerging disorder before sustained psychotic symptoms occur. While a prodrome may include rather unspecific symptoms and can only safely be diagnosed in retrospect, research over the last 15 years has brought about two rather specific sets of at-risk criteria for psychotic disorders, the ultra-high risk criteria (including attenuated psychotic symptoms, APS; brief limited intermittent symptoms, BLIPS) and the basic symptom criteria (including cognitive–perceptive symptoms, COPER; cognitive disturbances, COGDIS). The presence of one of these criteria is associated with an about B. G. Schimmelmann (&) F. Schultze-Lutter University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstr. 110, 3000 Bern 60, Switzerland e-mail: bschimme@aol.com

Early detection and intervention of psychosis in children and adolescents: urgent need for studies