A multi-perspective approach to early detection of psychosis

Background: Early detection of psychosis has been a highly investigated field of research in the last 20 years. However, decreasing transition rates show the need for further markers to improve prediction of transition of those with a potential risk of developing psychosis.
Methods: In the present doctoral thesis I aimed at improving early detection of psychosis by using a multimodal approach. Therefore, neurocognition, (potential) biological markers namely serum and plasma BDNF (study 1) and, prolactin (study 2), and psychopathology (study 3) were investigated. At-risk mental state (ARMS), first-episode psychosis (FEP), and in one study also chronic schizophrenia (CS) patients were recruited. Furthermore, a special focus was on potential gender differences because knowledge about these differences can lead to improved early detection and treatment.
Results: Altered BDNF levels were found, with lowest in ARMS, intermediate in FEP, and highest in CS. Plasma BDNF correlated positively with executive functioning. Also, prolactin levels were found to be altered in antipsychotic naïve ARMS and FEP patients, with hyperprolactinemia being more frequent in women compared to men in both groups even after correction for the normal biological variation. Lastly, small gender differences were found in very first self-perceived symptoms with women reporting more frequently anxiety and (sub-threshold) hallucinations and men more often cognitive and negative symptoms.
Discussion: Taken together the altered levels in the investigated biological markers are promising and might contribute to the improvement of early detection of psychosis. The observed small gender differences in psychopathology match previous results. A multimodal approach combining the different known predictors of psychosis is promising but more research is needed before the above named biological markers can be included in such a model.