Attenuated Psychosis in Youth and Adolescents: Clinical and Cultural Considerations from India

  • Avinash De Sousa
  • Amresh Shrivastava


Attenuated psychosis syndromes (APS) is a common condition that has been recognized in clinical settings in India. The following chapter addresses various issues in APS as seen in Indian clinical practice and the various ways in which these cases present. There are many common clinical scenarios that may lead to identification of the condition in India. Culturally sensitive factors that may serve as deterrents from seeking help and treatment are discussed, and the role of faith healers in the management of these patients is elaborated. The various types of treatment facilities available in India and methods commonly used in treatment are discussed. Personal-, social-, cultural-, and treatment-related factors that promote resolution or prevent development of APS in India are addressed. Assessment procedures for clinical evaluation and diagnosis of the condition are discussed along with components of psychoeducation that can be carried out with caregivers. Various treatment methods adopted and the course and prognosis of APS are presented from an Indian perspective.


  1. Addington, J., Piskulic, D., Liu, L., Lockwood, J., Cadenhead, K. S., Cannon, T. D., et al. (2017). Comorbid diagnoses for youth at clinical high risk of psychosis. Schizophrenia Research, 190, 90–95.PubMedPubMedCentralCrossRefGoogle Scholar
  2. Aggarwal, N. K., DeSilva, R., Nicasio, A. V., Boiler, M., & Lewis-Fernández, R. (2015). Does the Cultural Formulation Interview (CFI) for the fifth revision of the diagnostic and statistical manual of mental disorders (DSM-5) affect medical communication? A qualitative exploratory study from the New York site. Ethnicity & Health, 20, 1–28.CrossRefGoogle Scholar
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual for the classification of psychiatric disorders – 5th edition (DSM-5). American Psychiatric Publishing, New York.Google Scholar
  4. Bhatia, T., Deshpande, S. N., Gettig, E., Gottesman, I., Mishra, N. N., & Nimgaonkar, V. (2017). Estimation of risk of schizophrenia in first degree relatives an Indian sample. European Neuropsychopharmacology, 27, S402–S403.CrossRefGoogle Scholar
  5. Bhatia, T., Gettig, E. A., Gottesman, I. I., Berliner, J., Mishra, N. N., Nimgaonkar, V. L., & Deshpande, S. N. (2016). Stratifying empiric risk of schizophrenia among first degree relatives using multiple predictors in two independent Indian samples. Asian Journal of Psychiatry, 24, 79–84.PubMedPubMedCentralCrossRefGoogle Scholar
  6. Biswas, J., Gangadhar, B. N., & Keshavan, M. (2016). Cross cultural variations in psychiatrists’ perception of mental illness: A tool for teaching culture in psychiatry. Asian Journal of Psychiatry, 23, 1–7.PubMedCrossRefGoogle Scholar
  7. Boydell, J., Dean, K., Dutta, R., Giouroukou, E., Fearon, P., & Murray, R. (2007). A comparison of symptoms and family history in schizophrenia with and without prior cannabis use: Implications for the concept of cannabis psychosis. Schizophrenia Research, 93(1), 203–210.PubMedCrossRefGoogle Scholar
  8. Chaturvedi, S. K., Prasad, M. K., & Pathak, A. (2016). Beyond assessment of quality of life in schizophrenia: Cultural, clinical, and research perspectives from India, a case study. In A. G. Awad & A. N. P. Voruganti (Eds.), Beyond assessment of quality of life in schizophrenia (pp. 197–215). Cham, Switzerland: Springer International Publishing.Google Scholar
  9. Corin, E., Thara, R., & Padmavati, R. (2005). Shadows of culture in psychosis in India: A methodological exploration and illustration. International Review of Psychiatry, 17(2), 75–81.PubMedCrossRefGoogle Scholar
  10. Dhanasekaran, S., Loganathan, S., Dahale, A., & Varghese, M. (2017). Cultural considerations in the diagnosis and treatment of schizophrenia: A case example from India. Asian Journal of Psychiatry, 27, 113–114.PubMedCrossRefGoogle Scholar
  11. Fusar-Poli, P., Yung, A. R., McGorry, P., & Van Os, J. (2014). Lessons learned from the psychosis high-risk state: Towards a general staging model of prodromal intervention. Psychological Medicine, 44(1), 17–24.CrossRefGoogle Scholar
  12. Gautam, S., & Jain, N. (2010). Indian culture and psychiatry. Indian Journal of Psychiatry, 52(Suppl1), S309–S313.PubMedPubMedCentralCrossRefGoogle Scholar
  13. Grover, S., Chakrabarti, S., Kulharta, P., & Avasthi, A. (2017). A clinical guidelines for management of schizophrenia. Indian Journal of Psychiatry, 59(Suppl S1), 19–33.Google Scholar
  14. Jajodia, A., Kaur, H., Kumari, K., Gupta, M., Baghel, R., Srivastava, A., … Kukreti, R. (2015). Evidence for schizophrenia susceptibility alleles in the Indian population: An association of neurodevelopmental genes in case–control and familial samples. Schizophrenia Research, 162(1), 112–117.PubMedCrossRefGoogle Scholar
  15. Jangam, K., Muralidharan, K., Tansa, K. A., Raj, E. A., & Bhowmick, P. (2015). Incidence of childhood abuse among women with psychiatric disorders compared with healthy women: Data from a tertiary care centre in India. Child Abuse & Neglect, 50, 67–75.CrossRefGoogle Scholar
  16. Kacker, L., Mohsin, N., Dixit, A., Varadan, S., & Kumar, P. (2007). Study on child abuse: India, 2007. New Delhi, India: Ministry of Women and Child Development, Government of India.Google Scholar
  17. Khandelwal, S. K., Jhingan, H. P., Ramesh, S., Gupta, R. K., & Srivastava, V. K. (2004). India mental health country profile. International Review of Psychiatry, 16, 126–141.PubMedCrossRefGoogle Scholar
  18. Ksir, C., & Hart, C. L. (2016). Cannabis and psychosis: A critical overview of the relationship. Current Psychiatry Reports, 18, 1–11.CrossRefGoogle Scholar
  19. Kukshal, P., Kodavali, V. C., Srivastava, V., Wood, J., McClain, L., Bhatia, T., … Thelma, B. K. (2013). Dopaminergic gene polymorphisms and cognitive function in a north Indian schizophrenia cohort. Journal of Psychiatric Research, 47(11), 1615–1622.PubMedCrossRefGoogle Scholar
  20. Kulesza, M., Raguram, R., & Rao, D. (2014). Perceived mental health related stigma, gender, and depressive symptom severity in a psychiatric facility in South India. Asian Journal of Psychiatry, 9, 73–77.PubMedCrossRefGoogle Scholar
  21. Moore, T. H., Zammit, S., Lingford-Hughes, A., Barnes, T. R., Jones, P. B., Burke, M., & Lewis, G. (2007). Cannabis use and risk of psychotic or affective mental health outcomes: A systematic review. The Lancet, 370(9584), 319–328.CrossRefGoogle Scholar
  22. Padmavati, R., Thara, R., & Corin, E. (2005). A qualitative study of religious practices by chronic mentally ill and their caregivers in South India. International Journal of Social Psychiatry, 51, 139–149.PubMedCrossRefGoogle Scholar
  23. Proal, A. C., Fleming, J., Galvez-Buccollini, J. A., & DeLisi, L. E. (2014). A controlled family study of cannabis users with and without psychosis. Schizophrenia Research, 152(1), 283–288.PubMedCrossRefGoogle Scholar
  24. Sadath, A., Muralidhar, D., Varambally, S., Jose, J. P., & Gangadhar, B. N. (2014). Caregiving and help seeking in first episode psychosis: A qualitative study. Journal of Psychosocial Rehabilitation and Mental Health, 1, 47–53.CrossRefGoogle Scholar
  25. Schmidt, S. J., Schultze-Lutter, F., Schimmelmann, B. G., Maric, N. P., Salokangas, R. K. R., Riecher-Rossler, A., et al. (2015). EPA guidance on the early intervention in clinical high risk states of psychosis. European Psychiatry, 30, 388–404.CrossRefGoogle Scholar
  26. Sharma, S. K., & Gupta, S. (2017). Healthcare waste management scenario: A case of Himachal Pradesh (India). Clinical Epidemiology and Global Health, 5, 169–172.CrossRefGoogle Scholar
  27. Shrivastava, A., Bureau, Y., Rewari, N., & Johnston, M. (2013). Clinical risk of stigma and discrimination of mental illnesses: Need for objective assessment and quantification. Indian Journal of Psychiatry, 55, 178–182.PubMedPubMedCentralCrossRefGoogle Scholar
  28. Shrivastava, A., Johnston, M., & Bureau, Y. (2012). Stigma of mental illness-1: Clinical reflections. Mens Sana Monographs, 10, 70–84.PubMedPubMedCentralCrossRefGoogle Scholar
  29. Shrivastava, A., Johnston, M., Shah, N., & Bureau, Y. (2010). Redefining outcome measures in schizophrenia: Integrating social and clinical parameters. Current Opinion in Psychiatry, 23, 120–126.PubMedCrossRefGoogle Scholar
  30. Shrivastava, A., Johnston, M., Terpstra, K., & Bureau, Y. (2013). Pathways to psychosis in cannabis abuse. Clinical Schizophrenia & Related Psychoses, 9, 30–35.CrossRefGoogle Scholar
  31. Shrivastava, A., Johnston, M., Terpstra, K., & Bureau, Y. (2014). Cannabis and psychosis: Neurobiology. Indian Journal of Psychiatry, 56, 8–16.PubMedPubMedCentralCrossRefGoogle Scholar
  32. Shrivastava, A., McGorry, P. D., Tsuang, M., Woods, S. W., Cornblatt, B. A., Corcoran, C., & Carpenter, W. (2011). “Attenuated psychotic symptoms syndrome” as a risk syndrome of psychosis, diagnosis in DSM-V: The debate. Indian Journal of Psychiatry, 53, 57–65.PubMedPubMedCentralCrossRefGoogle Scholar
  33. Shrivastava, A., Shah, N., Johnston, M., Stitt, L., Thakar, M., & Chinnasamy, G. (2010). Effects of duration of untreated psychosis on long-term outcome of people hospitalized with first episode schizophrenia. Indian Journal of Psychiatry, 52, 164–167.PubMedPubMedCentralCrossRefGoogle Scholar
  34. Sowmya Bhaskaran, T. S., & Seshadri, S. P. (2016). Child sexual abuse-clinical challenges and practical recommendations. Journal of Indian Association for Child & Adolescent Mental Health, 12, 143–161.Google Scholar
  35. Swain, S. P., Behura, S. S., & Sahoo, S. S. (2017). Can the early symptoms of Attenuated Psychosis Syndrome be recognized: Caregivers’ perspective. International Journal of Medical Science and Public Health, 6(3), 606–613.Google Scholar
  36. Tandon, N., Shah, J., Keshavan, M. S., & Tandon, R. (2012). Attenuated psychosis and the schizophrenia prodrome: Current status of risk identification and psychosis prevention. Neuropsychiatry, 2, 345–353.PubMedPubMedCentralCrossRefGoogle Scholar
  37. Thippeswamy, H., Dahale, A., Desai, G., & Chandra, P. S. (2015). What is in a name? Causative explanatory models of postpartum psychosis among patients and caregivers in India. International Journal of Social Psychiatry, 61(8), 818–823.PubMedCrossRefGoogle Scholar
  38. Tseng, W. S., & Streltzer, J.. (2008). Culture and psychotherapy: A guide to clinical practice. American Psychiatric Publishing, New York.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Avinash De Sousa
    • 1
  • Amresh Shrivastava
    • 2
  1. 1.Department of PsychiatryLokmanya Tilak Municipal Medical CollegeMumbaiIndia
  2. 2.Lawson Health Research InstituteLondonCanada

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