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Early psychosis signs found in youth seeking mental health support

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Researchers at the University of Toronto and a partner hospital have found evidence that psychosis spectrum symptoms are often present in youth accessing mental health services.

Half of the 417 youth aged 11-24 included in the study, published in Biological Psychiatry: Cognitive Science and Neuroimaging, were shown to meet the threshold for having psychosis spectrum symptoms.

That means they are at higher risk of developing a psychotic disorder, a broad spectrum of psychotic disorders that includes – but is not limited to – schizophrenia and bipolar disorder 1.

Kristin Cleverley, a senior scientist at the Centre for Addiction and Mental Health (CAMH) and an associate professor at U of T’s Lawrence Bloomberg Faculty of Nursing, says the figure is higher than expected and suggests there is a large number of children with these symptoms who are accessing mental health services.

“Traditionally, early psychosis care starts when there is a serious presentation of psychotic symptoms, which usually occurs in the late teen years,” says Cleverley, adding that the study looks at early indicators that might predict whether a young person is more at risk of developing psychosis spectrum disorder and examines opportunities for earlier intervention.

“The current approach to identifying children at risk of developing a psychotic disorder is only about five per cent effective, but with this study we can start to assess certain patterns or changes in function that can signal if an earlier intervention may be beneficial.”

Psychosis spectrum disorder can be extremely disabling and is linked to cognitive impairment, long-term disability, and higher rates of death by suicide than other mental illnesses. Even without a diagnosis of psychosis, psychosis spectrum symptoms can severely affect youth.

The study is one of three projects being led as part of the Toronto Adolescent and Youth (TAY) Cohort Study that is set to follow 1,500 youth over the course of five years. The goal of the study is to better understand the populations of youth seeking mental health treatment, how their mental health symptoms and functioning change over time, and whether early predictors of psychosis spectrum disorder can be determined.

It was co-designed with patients and caregivers, as well as extensive engagement from clinicians. A novel aspect of the TAY Cohort Study is youth are given access to a patient-facing dashboard of their research results that is also integrated into their clinical record.

“We wanted to ensure that the study was embedded in the clinical program so that research assessments could be immediately utilized within clinical practice, including supporting decisions about interventions or services,” says Cleverley, who is the CAMH Chair in Mental Health Nursing Research.

Cleverley’s co-principal investigators include George Foussis, the scientific director of the Slaight Family Centre for Youth in Transition and chief of the schizophrenia division at CAMH and an associate professor of psychiatry in the Temerty Faculty of Medicine, and Aristotle Voineskos, vice-president of research and director of the Campbell Family Mental Health Research Institute at CAMH, and a professor of psychiatry at Temerty Medicine.

This longitudinal study will include a follow-up every six months and will provide researchers access to information about whether symptoms become chronic or episodic, and whether changes are related to developmental milestones, environmental stressors or changes to mental health services.

“Our goal with this research is really to characterize this population better so that we can identify new strategies that will complement existing strategies for early identification of youth at risk of psychosis,” says Cleverley. “It also creates an important opportunity for graduate students and researchers to develop sub-studies for this sample that will enable further research to improve youth mental health outcomes.”

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