SU8. Prevention Research in Major Psychoses Should Draw Concepts From Other Complex Disorders

Abstract

Background: Today's medicine suffers from silos between major psychiatric disorders (MP: schizophrenia, bipolar disorder, recurrent major depression) and other severe complex disorders (eg, cardiovascular, cancer, diabetes). Not only can different complex disorders affect the same patient but they partially share their genetic, environmental, and developmental roots. 1-3 Realizing these facts has high clinical and research signifcance. We compare here the common genetic and biological grounds between complex disorders, the methodological framework guiding clinical surveillance of at-risk children in other felds of medicine and how we can draw from them to inspire future clinical trials in MP prevention. Method(s): We reviewed the approaches and clinical guidelines for prevention and early detection of cardiovascular disorders, 4 diabetes, 5 and asthma 6 in children at risk. We could identify common core elements among existing guidelines. We then reviewed the literature on the childhood determinants of MP. Result(s): The literature showed that all these complex disorders share concepts and methods in their respective risk factors such as familial history, risk endophenotypes, subclinical traits or symptoms, and, later in the risk trajectory, help-seeking behaviors. Complex disorders also share the observation of progressive clustering of risk indicators in young individuals. In contrast to other disorders, no international clinical guidance exists for MP even though risk factors have been well identifed, eg, cognitive defcits, electrophysiological anomalies or psychotic-like experiences in childhood. Conclusion(s): The roots of many complex diseases including MP can be dug up from childhood. In most complex disorders except psychiatry, risk indicators and their aggregation along the risk trajectory have provided a basis for practice guidelines that have outlined evaluation requirements, types of surveillance and even early intervention in lifestyle, nutrition, remediation, or even medical treatment. For MP, even when the accumulated evidence is not suffcient to drive specifc preventive treatments, it is at least known how to identify the children most at risk. Realizing these empirical facts may help professionals and scientists to initiate a dialogue with academic authorities to foster clinical guidelines in psychiatry.