Adolescent family environment may reduce prodromal psychosis symptoms

Providing positive family involvement to adolescents who are in the prodromal stages of psychosis can help reduce symptoms and enhance social functioning, research indicates.

"Recently established methods for early detection of 'prodromal' individuals at imminent high risk for conversion to psychosis allow for investigation of additional predictive risk and protective factors," observe Mary O'Brien (University of California, Los Angeles, USA) and colleagues.

Noting that most prodromal individuals are adolescents, they investigated the impact of family factors, such as criticism, emotional over-involvement, warmth, and positive remarks, as measured on the Camberwell Family Interview, on symptom change and social outcome.

In all, 26 adolescents at imminent risk for conversion to psychosis participated in the study and were administered the Structured Interview for Prodromal Syndromes and the Strauss-Carpenter Outcome Scale at baseline and at follow-up 3 months later.

After taking into account symptom severity at baseline, the researchers found that caregivers' emotional over-involvement at baseline was associated with improvement in the negative symptoms of the patient, as well as in their level of social function.

"So-called parental emotional 'over'-involvement may be developmentally appropriate in adolescence," say the investigators, "serving an essential supportive function in navigating adolescent peer groups and school environments."

Similarly, positive remarks from caregivers' led to improvements in negative and disorganized symptoms, while warmth expressed by the family was associated with improved social functioning.

Of note, critical comments from family members were not related to patients' symptoms at follow-up, but O'Brien et al say that the majority of critical remarks were focused on patients' negative symptoms and irritability and aggression.

"Interventions aimed at helping families to cope effectively with negative symptoms expressed during adolescence may be particularly useful during the early prodromal stage before criticism and hostility have become entrenched," they suggest.

"The finding that four-fifths of the youth enrolled in this early intervention clinical research program have shown symptomatic improvement by the 3-month assessment point is very encouraging from an early detection/early intervention standpoint," the researchers conclude iin the journal Schizophrenia Research.

They add: "The interplay of family factors, treatment, and adolescent symptoms will be the focus of further investigation as these families are tracked longitudinally."

Schizophr Res 2006; 81: 269-275