title: Perinatal Risks and Childhood Premorbid Indicators of Later Psychosis: Next Steps for Early Psychosocial Interventions.
abstract: Schizophrenia and affective psychoses are debilitating disorders that together affect 2%-3% of the adult population. Approximately 50%-70% of the offspring of parents with schizophrenia manifest a range of observable difficulties including socioemotional, cognitive, neuromotor, speech-language problems, and psychopathology, and roughly 10% will develop psychosis. Despite the voluminous work on premorbid vulnerabilities to psychosis, especially on schizophrenia, the work on premorbid intervention approaches is scarce. While later interventions during the clinical high-risk (CHR) phase of psychosis, characterized primarily by attenuated positive symptoms, are promising, the CHR period is a relatively late phase of developmental derailment. This article reviews and proposes potential targets for psychosocial interventions during the premorbid period, complementing biological interventions described by others in this Special Theme issue. Beginning with pregnancy, parents with psychoses may benefit from enhanced prenatal care, social support, parenting skills, reduction of symptoms, and programs that are family-centered. For children at risk, we propose preemptive early intervention and cognitive remediation. Empirical research is needed to evaluate these interventions for parents and determine whether interventions for parents and children positively influence the developmental course of the offspring.
authors.affiliation: Department of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA; Department of Psychology, University of Massachusetts, Boston, MA; cliu@bidmc.harvard.edu.
authors.forename: Cindy H
authors.initials: CH
authors.lastname: Liu
authors.affiliation: Department of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA;
authors.forename: Matcheri S
authors.initials: MS
authors.lastname: Keshavan
authors.affiliation: Department of Psychology, University of Massachusetts, Boston, MA; Department of Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
authors.forename: Ed
authors.initials: E
authors.lastname: Tronick
authors.affiliation: Department of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA; Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Seidman
mesh_terms: D061345:Early Medical Intervention / Q000592:standards*; D006801:Humans; D011295:Prenatal Care / Q000592:standards*; D062706:Prodromal Symptoms; D011618:Psychotic Disorders / Q000517:prevention & control*; D012307:Risk Factors; D012559:Schizophrenia / Q000503:physiopathology* / Q000517:prevention & control*
keywords: early intervention; parenting; prevention; psychological; psychosis; schizophrenia; stress