An update in the prevention of psychotic spectrum disorders

  1. Fonseca-Pedrero, E. 1
  2. Inchausti, F. 2
  1. 1 Universidad de La Rioja
    info

    Universidad de La Rioja

    Logroño, España

    ROR https://ror.org/0553yr311

  2. 2 Complejo Hospitalario de Navarra, Spain
Revista:
Papeles del Psicólogo

ISSN: 0214-7823

Año de publicación: 2018

Volumen: 39

Número: 2

Páginas: 127-139

Tipo: Artículo

DOI: 10.23923/PAP.PSICOL2018.2860 SCOPUS: 2-s2.0-85049114337 DIALNET GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Papeles del Psicólogo

Repositorio institucional: lock_openAcceso abierto Editor lock_openAcceso abierto Editor

Resumen

The objective of this work was to carry out an update in the field of the prevention of psychotic spectrum disorders, specifically in early detection and early intervention. First, the conceptualization of the psychosis syndrome and its prevention are addressed. Second, the different procedures and measurement instruments for the evaluation of the risk condition are discussed. Then, the early interventions available for psychosis are reviewed; the staging model is presented; the effectiveness of such interventions is examined and some limitations and proposals for modification are discussed. A number of strengths and weaknesses in this field are highlighted as well as its future perspectives. Finally, by way of conclusion, a brief recapitulation is made. © 2018 Colegio Oficial de Psicologos. All rights reserved.

Referencias bibliográficas

  • Addington, J., Epstein, I., Liu, L., French, P., Boydell, K. M., y Zipursky, R. B. (2011). A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis. Schizophrenia Research, 125, 54–61.
  • Addington, J., Stowkowy, J., y Weiser, M. (2015). Screening tools for clinical high risk for psychosis. Early Intervention in Psychiatry, 9, 345-356.
  • Alameda, L., Golay, P., Baumann, P., Morandi, S., Ferrari, C., Conus, P., y Bonsack, C. (2016). Assertive outreach for “difficult to engage” patients: A useful tool for a subgroup of patients in specialized early psychosis intervention programs. Psychiatry Research, 239, 212–219.
  • Amminger, G. P., Schafer, M. R., Papageorgiou, K., Klier, C. M., Cotton, S. M., Harrigan, S. M., … Berger, G. E. (2010). Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Archives of General Psychiatry, 67, 146–154.
  • Bernardini, F., Attademo, L., Cleary, S. D., Luther, C., Shim, R. S., Quartesan, R., y Compton, M. T. (2017). Risk prediction models in psychiatry: Toward a new frontier for the prevention of mental illnesses. Journal of Clinical Psychiatry, 78, 572–583.
  • Bobes, J., y Saiz, J. (2013). Impacto social de la esquizofrenia. Madrid: Janssen Pharmaceutica N.V.
  • Borsboom, D. (2017). A network theory of mental disorders. World Psychiatry, 16, 5–13.
  • Carpenter, W. (2018). Clinical high risk controversies and challenge for the experts. Schizophrenia Bulletin, 44, 223-225. doi: 10.1093/schbul/sbx182.
  • Carrión, R., Correll, C., Auther, A., y Cornblatt, B. (2017). A severity-based clinical staging model for the psychosis prodrome: longitudinal findings from the new york recognition and prevention program. Schizophrenia Bulletin, 43, 64– 74.
  • Cornblatt, B. A., y Carrión, R. E. (2016). Deconstructing the psychosis risk syndrome moving the field of prevention forward. JAMA Psychiatry, 73, 105-106. https://doi.org/10.1001/jamapsychiatry.2015.2454
  • Csillag, C., Nordentoft, M., Mizuno, M., McDaid, D., Arango,
  • C., Smith, J., … Jones, P. (2017). Early intervention in psychosis: From clinical intervention to health system implementation. Early Intervetion in Psychiatry, doi: 10.1111/eip.12514.
  • Cuesta, M. J., y Peralta, V. (2016). Going beyond classic descriptions to future phenomenology of schizophrenia. JAMA Psychiatry, 73(10), 1010.
  • Davis, J., Eyre, H., Jacka, F. N., Dodd, S., Dean, O., McEwen, S., … Berk, M. (2016). A review of vulnerability and risks for schizophrenia: Beyond the two hit hypothesis. Neuroscience and Biobehavioral Reviews, 65, 185-194.
  • Debbané, M., Eliez, S., Badoud, D., Conus, P., Flückiger, R., y Schultze-Lutter, F. (2015). Developing psychosis and its risk states through the lens of schizotypy. Schizophrenia Bulletin, 41, S396-407.
  • Dickson, H., Laurens, K. R., Cullen, A. E., y Hodgins, S. (2012). Meta-analyses of cognitive and motor function in youth aged 16 years and younger who subsequently develop schizophrenia. Psychological Medicine, 42, 743–755.
  • Dietsche, B., Kircher, T., y Falkenberg, I. (2017). Structural brain changes in schizophrenia at different stages of the illness: A selective review of longitudinal magnetic resonance imaging studies. Australian y New Zealand Journal of Psychiatry, 51, 500–508.
  • Duffy, A., Malhi, G. S., y Grof, P. (2017). Do the trajectories of bipolar disorder and schizophrenia follow a universal staging model? Canadian Journal of Psychiatry, 62, 115-122. https://doi.org/10.1177/0706743716649189
  • Fonseca-Pedrero, E. (2017). Análisis de redes: ¿una nueva forma de comprender la psicopatología? Revista de Psiquiatria y Salud Mental, 10, 206-215.
  • Fonseca-Pedrero, E. (2018). Análisis de redes en Psicología. Papeles del Psicólogo, 39, 1-12.
  • Fonseca-Pedrero, E. (2018). Evaluación de los trastornos del espectro psicótico. Madrid: Pirámide.
  • Fonseca-Pedrero, E., y Debbané, M. (2018). Evaluación del riesgo de psicosis. En E. Fonseca-Pedrero (coord.) Evaluación de los trastornos del espectro psicótico (pp. 381-429). Madrid: Pirámide.
  • Fonseca-Pedrero, E., Gooding, D., Debbané, M., y Muñiz, J. (2016). Psychopathology: Psychosis assessment and highrisk paradigms. En D. Bartram (Ed.), The ITC International Handbook of Testing and Assessment. Oxford, UK: Oxford University Press.
  • Fonseca-Pedrero, E., Paino, M., y Fraguas, D. (2013). DSM-5: ¿Síndrome de psicosis atenuada? Papeles del Psicólogo, 34, 190–207.
  • Fonseca Pedrero, E., y Debbané, M. (2017). Schizotypal traits and psychotic-like experiences during adolescence: An update. Psicothema, 29, 5–17.
  • Fraser, R., Berger, G., y McGorry, P. (2006). Emerging psychosis in young people Part 2 key issues for acute management. Australian Family Physician, 35, 323-327. Fusar-Poli, P., Bonoldi, I., Yung, A. R., Borgwardt, S., Kempton, M. J., Valmaggia, L., … McGuire, P. (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry, 69, 220– 229.
  • Fusar-Poli, P., Byrne, M., Badger, S., Valmaggia, L. R., y McGuire, P. K. (2013). Outreach and support in South London (OASIS), 2001-2011: Ten years of early diagnosis and treatment for young individuals at high clinical risk for psychosis. European Psychiatry, 28, 315–326.
  • Fusar-Poli, P., Carpenter, W. T., Woods, S. W., y McGlashan, T. H. (2014). Attenuated psychosis syndrome: ready for DSM-5.1? Annual Review of Clinical Psychology, 10, 155– 192.
  • Fusar-Poli, P., Deste, G., Smieskova, R., Barlati, S., Yung, A. R., Howes, O., … Borgwardt, S. (2012). Cognitive functioning in prodromal psychosis: a meta-analysis. Archives of General Psychiatry, 69, 562–571.
  • Fusar-Poli, P., McGorry, P., y Kane, J. (2017). Improving outcomes of first-episode psychosis: an overview. World Psychiatry, 16, 251–265.
  • Fusar-Poli, P., Radua, J., McGuire, P., y Borgwardt, S. (2012). Neuroanatomical maps of psychosis onset: voxel-wise metaanalysis of antipsychotic-naive VBM studies. Schizophrenia Bulletin, 38, 1297–1307.
  • Fusar-Poli, P., Rocchetti, M., Sardella, A., Avila, A., Brandizzi, M., Caverzasi, E., … McGuire, P. (2015). Disorder, not just state of risk: meta-analysis of functioning and quality of life in people at high risk of psychosis. British Journal of Psychiatry, 207, 198–206.
  • Fusar-Poli, P., Rutigliano, G., Stahl, D., Davies, C., Bonoldi, I., Reilly, T., y McGuire, P. (2017). Development and validation of a clinically based risk calculator for the transdiagnostic prediction of psychosis. JAMA Psychiatry, 74, 493–500.
  • Fusar-Poli, P., Rutigliano, G., Stahl, D., Schmidt, A., RamellaCravaro, V., Hitesh, S., y McGuire, P. (2016). Deconstructing pretest risk enrichment to optimize prediction of psychosis in individuals at clinical high risk. JAMA Psychiatry, 73(12), 1260.
  • Fusar-Poli, P., Tantardini, M., De Simone, S., Ramella-Cravaro, V., Oliver, D., Kingdon, J., … McGuire, P. (2017). Deconstructing vulnerability for psychosis: Meta-analysis of environmental risk factors for psychosis in subjects at ultra high-risk. European Psychiatry, 40, 65-75.
  • Fusar-Poli, P., y Yung, A. R. (2012). Should attenuated psychosis syndrome be included in DSM-5? The Lancet, 379(9816), 591-592.
  • Guloksuz, S., y van Os, J. (2018). The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum. Psychological Medicine, 48, 229-244.
  • Häfner, H., y An Der Heiden, W. (1999). The course of schizophrenia in the light of modern follow-up studies: The ABC and WHO studies. European Archives of Psychiatry and Clinical Neuroscience, 249(Suppl. 4), IV14-IV26.
  • Huber, G. (1983). Das Konzept substratnaher Basissymptome und seine Bedeutung für Theorie und Therapie schizophrener Erkrankungen. Nervenarzt, 54, 23–32.
  • Humiston, S. G., Szilagyi, P. G., Iwane, M. K., Schaffer, S. J., Santoli, J., Shone, L., … Schwartz, B. (2004). The feasibility of universal influenza vaccination for infants and toddlers. Archives of Pediatrics & Adolescent Medicine, 158(9), 867– 874.
  • Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., … Wang, P. (2010). Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. The American Journal of Psychiatry, 167(7), 748–751.
  • Insel, T. R. (2017). Digital phenotyping: Technology for a new science of behavior. JAMA, 318, 1215-1216. https://doi.org/10.1001/jama.2017.11295
  • Jeste, D. V., Palmer, B. W., y Saks, E. R. (2017). Why we need positive psychiatry for schizophrenia and other psychotic disorders. Schizophrenia Bulletin, 43(2), 227–229.
  • Juuhl-Langseth, M., Holmén, A., Thormodsen, R., Øie, M., y Rund, B. R. (2014). Relative stability of neurocognitive deficits in early onset schizophrenia spectrum patients. Schizophrenia Research, 156(2–3), 241–247.
  • Kaymaz, N., Drukker, M., Lieb, R., Wittchen, H. U., Werbeloff, N., Weiser, M., … van Os, J. (2012). Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results. Psychological Medicine, 20, 1–15.
  • Kendler, K. S. (2014). The structure of psychiatric science. American Journal of Psychiatry,171, 931-938.
  • Keshavan, M. S., DeLisi, L. E., y Seidman, L. J. (2011). Early and broadly defined psychosis risk mental states. Schizophrenia Research, 126, 1–10.
  • Keshavan, M. S., Nasrallah, H. A., y Tandon, R. (2011). Schizophrenia, “Just the Facts” 6. Moving ahead with the schizophrenia concept: From the elephant to the mouse. Schizophrenia Research, 127, 3-13.
  • Keshavan, M. S., Tandon, R., Boutros, N. N., y Nasrallah, H. A. (2008). Schizophrenia, “just the facts”: What we know in 2008. Part 3: Neurobiology. Schizophrenia Research, 106, 89–107.
  • Klosterkötter, J. (2014). The usefulness for indicated prevention of severe mental disorders should play a central part in the further development of CBT. World Psychiatry, 13, 259260.
  • Kraepelin, E. (1919). Dementia praecox and paraphrenia. Huntington, N.Y.: Krieger (Trad.1971).
  • Laine, A., Anttila, M., y Valimaki, M. (2016). Modification of an Internet-based patient education program for adults with schizophrenia spectrum disorder to suit adolescents with psychosis. Informatics for Health y Social Care, 41(3), 230– 246.
  • Larsen, T. K., Melle, I., Auestad, B., Haahr, U., Joa, I., Johannessen, J. O., … McGlashan, T. (2011). Early detection of psychosis: positive effects on 5-year outcome. Psychological Medicine, 41, 1461–1469.
  • Lemos Giráldez, S., Fonseca-Pedrero, E., Paino, M., y Vallina, O. (2015). Esquizofrenia y otros trastornos psicóticos. Madrid: Síntesis.
  • Linscott, R. J., y van Os, J. (2013). An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional expression across mental disorders. Psychological Medicine, 43, 1133–1149.
  • Lyne, J., O’Donoghue, B., Roche, E., Renwick, L., Cannon, M., y Clarke, M. (2017). Negative symptoms of psychosis: A life course approach and implications for prevention and treatment. Early Intervention in Psychiatry. https://doi.org/10.1111/eip.12501
  • Maj, M. (2011). Understanding the pathophysiology of schizophrenia: are we on the right track? Schizophrenia Research, 127, 20–21.
  • Marshall, M., y Rathbone, J. (2011). Early intervention for psychosis. In Cochrane Database of Systematic Reviews, Jun 15;(6):CD004718. doi: 10.1002/14651858.CD004718.pub3.
  • McGlashan, T. H., Zipursky, R. B., Perkins, D., Addington, J., Miller, T., Woods, S. W., … Breier, A. (2006). Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. American Journal of Psychiatry, 163(5), 790–799.
  • McGorry, P., Johanessen, J. O., Lewis, S., Birchwood, M., Malla, A., Nordentoft, M., … Yung, A. (2010). Early intervention in psychosis: Keeping faith with evidence-based health care. Psychological Medicine, 40, 399-404.
  • McGorry, P., y Van Os, J. (2013). Redeeming diagnosis in psychiatry: Timing versus specif i ci ty. The Lancet, 381(9863), 343–345.
  • Millan, M. J., Andrieux, A., Bartzokis, G., Cadenhead, K., Dazzan, P., Fusar-Poli, P., … Weinberger, D. (2016). Altering the course of schizophrenia: progress and perspectives. Nature Reviews Drug Discovery, 15(7), 485–515.
  • Miller, T. J., McGlashan, T. H., Rosen, J. L., Cadenhead, K., Ventura, J., McFarlane, W., … Woods, S. W. (2003). Prodromal Assessment with the Structured Interview for Prodromal Syndromes and the Scale of Prodromal Symptoms: Predictive Validity, Interrater Reliability, and Training to Reliability. Schizophrenia Bulletin, 29(4), 703–715.
  • Miret, S., Fatjó-Vilas, M., Peralta, V., y Fañanás, L. (2016). Síntomas básicos en la esquizofrenia, su estudio clínico y relevancia en investigación. Revista de Psiquiatría y Salud Mental, 9(2), 111–122.
  • Mongan, D., Shannon, C., Hanna, D., Boyd, A., y Mulholland, C. (2017). The association between specific types of childhood adversity and attenuated psychotic symptoms in a community sample. Early Intervention in Psychiatry. https://doi.org/10.1111/eip.12478
  • Morrison, A. P., French, P., Stewart, S. L. K., Birchwood, M., Fowler, D., Gumley, A. I., … Dunn, G. (2012). Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial. BMJ, 344, e2233.
  • Morrison, A. P., Turkington, D., Pyle, M., Spencer, H., Brabban, A., Dunn, G., … Hutton, P. (2014). Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. Lancet, 383(9926), 1395–403.
  • Mosholder, A. D., Gelperin, K., Hammad, T. a, Phelan, K., y Johann-Liang, R. (2009). Hallucinations and other psychotic symptoms associated with the use of attention-deficit/hyperactivity disorder drugs in children. Pediatrics, 123(2), 611– 616.
  • Muñiz, J., Hernández, A., y Ponsoda, V. (2015). Nuevas directrices sobre el uso de los tests: investigación, control de calidad y seguridad. Papeles del Psicólogo, 36, 161–173.
  • Myin-Germeys, I., Oorschot, M., Collip, D., Lataster, J., Delespaul, P., y van Os, J. (2009). Experience sampling research in psychopathology: opening the black box of daily life. Psychological Medicine, 39(9), 1533.
  • Nelson, B., McGorry, P. D., Wichers, M., Wigman, J. T. W., y Hartmann, J. A. (2017). Moving from static to dynamic models of the onset of mental disorder. JAMA Psychiatry, 74, 528 -534.
  • Nelson, B., Parnas, J., y Sass, L. A. (2014). Disturbance of minimal self (ipseity) in schizophrenia: clarification and current status. Schizophrenia Bulletin, 40(3), 479–482.
  • Niendam, T. A., Tully, L. M., Iosif, A. M., Kumar, D., Nye, K. E., Denton, J. C., … Pierce, K. M. (2018). Enhancing early psychosis treatment using smartphone technology: A longitudinal feasibility and validity study. Journal of Psychiatric Research, 96, 239–246.
  • Obiols, J. E., y Barrantes-Vidal, N. (2014). Signos de riesgo y detección precoz de psicosis. Madrid: Síntesis.
  • Parnas, J. (2015). Differential diagnosis and current polythetic classification. World Psychiatry, 14, 284–287.
  • Pérez-Álvarez, M. (2012). Esquizofrenia y cultura moderna: Razones de la locura. Psicothema, 24, 1-9.
  • Riley, M., Patterson, V., Lane, J. C., Won, K. M., y Ranalli, L. (2018). The Adolescent champion model: Primary care becomes adolescent-centered via targeted quality improvement. Journal of Pediatrics, 193, 229-236. doi: 10.1016/j.jpeds.2017.09.084
  • Ruhrmann, S., Bechdolf, A., Kühn, K. U., Wagner, M., Schultze-Lutter, F., Janssen, B., … Klosterkötter, J. (2007). Acute effects of treatment for prodromal symptoms for people putatively in a late initial prodromal state of psychosis. British Journal of Psychiatry, 191(Suppl. 51), s88-95. doi: 10.1192/bjp.191.51.s88.
  • Schmidt, A., Cappucciati, M., Radua, J., Rutigliano, G., Rocchetti, M., Dell’Osso, L., … Fusar-Poli, P. (2016). Improving prognostic accuracy in subjects at clinical high risk for psychosis: systematic review of predictive models and metaanalytical sequential testing simulation. Schizophrenia Bulletin, 43, 375-388.
  • Schultze-Lutter, F., Klosterkötter, J., y Ruhrmann, S. (2014). Improving the clinical prediction of psychosis by combining ultra-high risk criteria and cognitive basic symptoms. Schizophrenia Research, 154(1–3), 100–106.
  • Schultze-Lutter, F., Michel, C., Schmidt, S. J., Schimmelmann, B. G., Maric, N. P., Salokangas, R. K. R., … Klosterkötter, J. (2015). EPA guidance on the early intervention in clinical high risk states of psychoses. European Psychiatry, 30(3), 388–404.
  • Segarra, R. (2013). Abordaje integral de las fases iniciales de las psicosis. Una visión crítica. Madrid: Editorial Médica Panamericana.
  • Stafford, M. R., Jackson, H., Mayo-Wilson, E., Morrison, A. P., y Kendall, T. (2013). Early interventions to prevent psychosis: systematic review and meta-analysis. BMJ, 346, f185.
  • Tandon, R., Keshavan, M. S., y Nasrallah, H. A. (2008). Schizophrenia, “Just the Facts”: What we know in 2008. Part 1: Overview. Schizophrenia Research, 100, 4–19.
  • Tandon, R., Nasrallah, H. A., y Keshavan, M. S. (2009). Schizophrenia, “just the facts” 4. Clinical features and conceptualization. Schizophrenia Research, 110, 1–23.
  • Tsuang, M. T., Van Os, J., Tandon, R., Barch, D. M., Bustillo, J., Gaebel, W., … Carpenter, W. (2013). Attenuated psychosis syndrome in DSM-5. Schizophrenia Research, 150, 31–35.
  • Valmaggia, L. R., Byrne, M., Day, F., Broome, M. R., Johns, L., Howes, O., … McGuire, P. K. (2015). Duration of untreated psychosis and need for admission in patients who engage with mental health services in the prodromal phase. British Journal of Psychiatry, 207(2), 130–134.
  • van der Gaag, M., Nieman, D. H., Rietdijk, J., Dragt, S., Ising, H. K., Klaassen, R. M., … Linszen, D. H. (2012). Cognitive behavioral therapy for subjects at ultrahigh risk for developing psychosis: a randomized controlled clinical trial. Schizophrenia Bulletin, 38, 1180–1188.
  • van der Gaag, M., Smit, F., Bechdolf, A., French, P., Linszen, D. H., Yung, A. R., … Cuijpers, P. (2013). Preventing a first episode of psychosis: meta-analysis of randomized controlled prevention trials of 12 month and longer-term followups. Schizophrenia Research, 149(1–3), 56–62.
  • van Os, J., Delespaul, P., Wigman, J., Myin-Germeys, I., y Wichers, M. (2013). Beyond DSM and ICD: introducing “precision diagnosis” for psychiatry using momentary assessment technology. World Psychiatry, 12, 113–117.
  • van Os, J., y Guloksuz, S. (2017). A critique of the “ultra-high risk” and “transition” paradigm. World Psychiatry, 16(2), 200–206.
  • van Os, J., y Kapur, S. (2009). Schizophrenia. Lancet, 374, 635–645.
  • van Os, J., Kenis, G., y Rutten, B. P. (2010). The environment and schizophrenia. Nature, 468, 203–312.
  • van Os, J., y Linscott, R. J. (2012). Introduction: The extended psychosis phenotype Relationship with schizophrenia and with ultrahigh risk status for psychosis. Schizophrenia Bulletin, 38(2), 227–230.
  • van Os, J., y Reininghaus, U. (2016). Psychosis as a transdiagnostic and extended phenotype in the general population. World Psychiatry, 15(2), 118–124.
  • van Os, J., Reininghaus, U., y Meyer-Lindenberg, A. (2017). The Search for Environmental Mechanisms Underlying the Expression of Psychosis: Introduction. Schizophrenia Bulletin, 43, 283–286.
  • Wyatt, R. J., y Henter, I. (2001). Rationale for the study of early intervention. Schizophrenia Research, 51(1), 69–76.
  • Yung, A. R., y McGorry, P. D. (2007). Prediction of psychosis: setting the stage. British Journal of Psychiatry, 191, s1-8.
  • Yung, A. R., Phillips, L. J., Nelson, B., Francey, S. M., PanYuen, H., Simmons, M. B., … McGorry, P. D. (2011). Randomized controlled trial of interventions for young people at ultra high risk for psychosis: 6-Month analysis. Journal of Clinical Psychiatry, 72(4), 430–440.
  • Yung, A. R., Yuen, H. P., McGorry, P. D., Phillips, L. J., Kelly, D., Dell’Olio, M., … Buckby, J. (2005). Mapping the onset of psychosis-the Comprehensive Assessment of At Risk Mental States (CAARMS). Australian and New Zealand Journal of Psychiatry, 39, 964–971.
  • Zarogianni, E., Storkey, A. J., Johnstone, E. C., Owens, D. G. C., y Lawrie, S. M. (2017). Improved individualized prediction of schizophrenia in subjects at familial high risk, based on neuroanatomical data, schizotypal and neurocognitive features. Schizophrenia Research, 181, 6–12.