Attenuated Psychosis Syndromes Among Brazilian Youth and Young Adults: Early Identification and Intervention
Although research in early stages of mental disorders has been consistently increasing in Brazil, most findings are related to neurobiological processes associated with ultrahigh risk symptoms. Alterations in sleep patterns and peripheral blood biomarkers have been the main focus of original papers. There is currently no cohesive strategy for addressing this issue in the public health system, and the only existing service is linked to a university, PRISMA (Program of Recognition and Intervention in At-Risk Mental States subjects), a center providing specialized assessment and care for help-seeking individuals presenting with an attenuated psychosis syndromes (APS). The center is located in a central region of São Paulo functioning inside the Schizophrenia Program from the Federal University of São Paulo (UNIFESP).
Brazil has a very heterogenic and diverse population. In this context, instead of facing particular culturally relevant assessment and intervention approaches, the primary challenge is the multifaceted clinical presentation and inconsistent resources available for treatment. Furthermore, the nature of recent reforming of the Brazilian psychiatric system, a general lack of available services, limited access to specialized literature in the public health system, and inadequate mental health literacy among the general population may represent barriers to referrals. Several strategies have been implemented to improve referrals, like contact between PRISMA and primary healthcare services, training programs for teachers, lectures and partnerships with psychology clinics from other universities, and training programs for psychiatric residents during their formal academic education. Collaboration with other programs around the world has been critical to strengthening research and clinical knowledge.
KeywordsPsychosis At-risk mental states Ultra high risk Adolescents Attenuated psychosis syndromes
- de Araújo, T. C. B. C., Moreira, V., & Cavalcante Júnior, F. S. (2008). Sofrimento de Sávio: Estigma de ser doente mental em Fortaleza. Fractal: Revista de Psicologia, 20(1), 119–128.Google Scholar
- Klosterkötter, J., Schultze-Lutter, F., Wieneke, A., Picker, H., & Steinmeyer, E. (2001). Introduction and Reliability of the first version of the Schizophrenia Prediction Instrument (SPI-A). Paper presented at the Schizophrenia research.Google Scholar
- Mansur, R. B., Zugman, A., Asevedo, E. M., da Cunha, G. R., Bressan, R. A., & Brietzke, E. (2012). Cytokines in schizophrenia: Possible role of anti-inflammatory medications in clinical and preclinical stages. Psychiatry and Clinical Neurosciences, 66(4), 247–260. https://doi.org/10.1111/j.1440-1819.2012.02354.xPubMedCrossRefGoogle Scholar
- Moreno, R., & Moreno, D. (1998). Escalas de avaliação clínica em psiquiatria e psicofarmacologia: Escalas de avaliação para depressão de Hamilton (HAM-D) e Montgomery-Asberg (MADRS). Revista de Psiquiatria Clínica (São Paulo), 25(5), 1–17.Google Scholar
- Morosini, P., Magliano, L., Brambilla, L., Ugolini, S., & Pioli, R. (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica, 101(4), 323–329.PubMedGoogle Scholar
- Santoro, M. L., Gadelha, A., Ota, V. K., Cunha, G. R., Asevedo, E., Noto, C. S., … Belangero, S. I. (2015). Gene expression analysis in blood of ultra-high risk subjects compared to first-episode of psychosis patients and controls. World Journal of Biological Psychiatry, 1–6. https://doi.org/10.3109/15622975.2015.1048724PubMedCrossRefGoogle Scholar
- Vieira, M. A., Gadelha, A. A., Moriyama, T. S., Bressan, R. A., & Bordin, I. A. (2014). Evaluating the effectiveness of a training program that builds teachers’ capability to identify and appropriately refer middle and high school students with mental health problems in Brazil: An exploratory study. BMC Public Health, 14(1), 1.CrossRefGoogle Scholar
- Yung, A. R., Yung, A. R., Pan Yuen, H., Mcgorry, P. D., Phillips, L. J., Kelly, D., … Killackey, E. (2005). Mapping the onset of psychosis: The comprehensive assessment of at-risk mental states. Australian and New Zealand Journal of Psychiatry, 39(11–12), 964–971.PubMedPubMedCentralCrossRefGoogle Scholar
- Zanini, M., Castro, J., Coelho, F. M., Bittencourt, L., Bressan, R. A., Tufik, S., & Brietzke, E. (2013). Do sleep abnormalities and misaligned sleep/circadian rhythm patterns represent early clinical characteristics for developing psychosis in high risk populations? Neuroscience and Biobehavioral Reviews, 37(10), 2631–2637.PubMedCrossRefGoogle Scholar
- Zanini, M. A., Castro, J., Cunha, G. R., Asevedo, E., Pan, P. M., Bittencourt, L., … Brietzke, E. (2015). Abnormalities in sleep patterns in individuals at risk for psychosis and bipolar disorder. Schizophrenia Research, 169(1–3), 262–267. https://doi.org/10.1016/j.schres.2015.08.023PubMedCrossRefGoogle Scholar