Factors that increase the risk of having a psychosis

The onset of a psychotic disorder is multicausal.

Mental Health Area. Sant Joan de Déu Hospital Barcelona

Children and adolescents with psychotic disorders represent 0.3% of the child and youth population, reaching 1% of the total population by adulthood. Although the incidence of the disorder is not comparable to that of other more common disorders, the severity of this illness and the risk of chronicity are so high that a World Health Organization (WHO 2004) report ranked schizophrenia ninth among diseases with the greatest associated disability burden, making it one of the mental disorders that causes the most psychological (individual and family) and social suffering.

The causes of these disorders are currently unknown. While it is true that, within the group of psychoses, there are two subgroups with known causes (drug-induced psychoses and psychoses due to medical conditions), the cause of idiopathic psychoses, as the name suggests, is unknown. In this regard, there are several explanatory hypotheses:

Biological hypotheses.
These are theories that rely on biological and genetic factors to describe the causes of the disease. In this regard, many studies have been conducted in the genetic field of disease. These studies, on the one hand, are based on determining the genetic load we pass on to our offspring. Thus, studies of children of patients with psychotic disorders have identified a high degree of genetic predisposition (up to 80% heritability of the disease). On the other hand, more recently, several genetic studies are attempting to identify specific genes that cause the disease. In this sense, several genes have been identified, but so far, none of the studies have shown conclusive results to identify a single gene as the sole cause of the disease.
Neurobiological hypotheses.
These hypotheses are primarily based on a malfunction of neuronal factors (brain mechanisms) as the cause of the disease. In this field, studies are conducted on brain size, the size of structures within the brain, brain function mechanisms, and so on. To date, no single mechanism has been identified as the cause of the disease, but many common indicators and factors have been identified within this field.
Environmental hypotheses.
These hypotheses identify environmental factors such as stress, stressful life events, and where we live (rural or urban environment), etc., as causes of these illnesses. However, no single environmental indicator has been identified as a trigger for psychotic disorders.

A study reveals that a high percentage of children and adolescents with early-onset psychosis suffer from clinical depression

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Researchers have determined that the causes of these disorders, while not common and not having a single cause as in other diseases, are a combination of factors. Therefore, the most compelling hypotheses for explaining these illnesses are biopsychosocial, meaning they are based on understanding multiple causes as determinants of the disease.

While it is true that we do not yet have a single cause that explains how the disorder originates, research over the years with the aforementioned hypotheses has led to the understanding of several factors that make a person more at risk of suffering from a psychotic illness.

Risk factors for psychosis:

Family history of psychotic disorder.
This field has been studied primarily in the context of schizophrenia, but also in other psychotic disorders. In this regard, science has shown that having a parent with the illness increases the risk of developing it by 80%.
Stress.
It is one of the causes or contributing factors in the development of several mental illnesses. In the case of psychotic disorders, it has been shown that the presence of stressful experiences throughout life can interact with other biological susceptibility factors and contribute to increasing the risk of developing a psychotic disorder.

Stress, a risk factor for psychosis

Consumption of toxic substances.
Drug use, including cannabis and cocaine, has been identified as a risk factor in the scientific literature. Both substance use and negative stressful events have been linked to an increased risk of developing psychotic symptoms in children and adolescents, as well as a higher risk of these symptoms persisting.
Family atmosphere.
Among stressful life events, one of the factors scientifically studied is the family climate. From the systemic school of psychology, which focuses on the study of family and interpersonal relationships, the concept of expressed emotion has been explored. Expressed emotion is defined as the communication styles present in families, and five types of communication styles are described: three negative and two positive: critical comments (criticism), hostility, over-involvement, warmth, and affection. In the field of schizophrenia, several research studies have linked relapses in schizophrenic patients with the presence of high levels of the communication styles of criticism, hostility, and over-involvement.
Presence of attenuated psychotic symptoms and psychotic experiences.
Currently, there is increasing evidence that the presence of mild or brief positive psychotic symptoms increases the risk of developing a psychotic disorder later in life.
Adherence to treatment.
Attending consultations and following the treatment plan indicated by the psychiatrist is a protective factor and has a good prognosis.

The importance of early detection in psychosis

Several studies have shown that early detection of these disorders is a crucial factor in the course of illness for patients diagnosed with psychotic disorders. It has been demonstrated that the time between the onset of the first symptoms and the start of treatment, known as the duration of untreated psychosis, is a factor involved in the progression of the illness. Thus, the shorter this time, the better the prognosis for individuals diagnosed with psychosis.

In this regard, and taking into account the risk factors studied over time, efforts have been made in recent decades to detect psychotic symptoms in their early stages. Several research groups worldwide are studying patients at risk of developing the disorder with the aim of prevention.

Currently, individuals at risk are identified using clinical criteria based on the presence of mild or attenuated psychotic symptoms. We speak of attenuated psychotic symptoms when a person experiences delusions but is still able to question their veracity, or when a person has perceptions that lead them to doubt their reality. Although this is still a field of study, the specialization of early detection services is yielding promising results and, above all, is contributing to a reduction in the duration of untreated psychosis. Given all the positive results being observed, early diagnosis of these disorders is considered of paramount importance.

This is an original article from the Escola de Salut of the Sant Joan de Déu Hospital Barcelona , from the 12th FAROS Report "A look at the mental health of adolescents - Keys to understanding and supporting them".