New insights can help prevent psychosis relapses in adolescents and young adults

New findings from McGill University researchers could help clinicians understand the progression of delusions in adolescents and young adults. These delusions point to the need for early intervention to prevent full-blown psychosis relapse.

Delusions—strong beliefs that are inconsistent with commonly accepted reality—are a defining symptom of psychosis, but are poorly understood.

For the first time, researchers examined whether delusions, such as paranoia or grandiosity, remain the same or change between psychotic episodes in adolescents and young adults undergoing early intervention treatment.

Strikingly, most patients did not relapse at all after their first episode, demonstrating the effectiveness of early intervention and highlighting the need for improved access, the researchers said. According to Youth Mental Health Canada, an estimated 75% of children with mental disorders do not use specialized treatment services.

“Early intervention is essential if we are to give young people the best chance of lasting recovery,” said lead author Gil Grunfeld, a recent graduate of McGill’s department of psychiatry and currently a doctoral candidate at Boston University.

The study, published in JAMA Psychiatryfound that in the less likely cases of relapse, patients almost always had the same type of delusion as during their first episode.

“The recurrence of similar stories may suggest that the ghost is reflecting the same patterns as in previous episodes,” Grunfeld said.

“Recognizing this pattern of delusions in people who relapse can help clinicians understand their patients’ experience and tailor the care they provide,” said Dr. Jai Shah, an associate professor in McGill’s department of psychiatry and a researcher at the Douglas Hospital Research Centre.

Delusions often persisted even when other symptoms improved, suggesting that delusions may require different treatment strategies, he added.

“Delusions are often very disturbing and difficult to define, which makes closing the research gap all the more important. There is much future work to be done,” Grunfeld said.

The researchers followed about 600 patients, ages 14 to 35, for up to two years. All were treated at an early intervention service for psychosis in Montreal.