The concepts of Clinical High Risk of psychotic transition (CHRp) and emerging psychosis are rapidly evolving. Their development and assessment have been mainly driven by adult psychiatry. However, adolescents present developmental and psychological characteristics that the CAARMS does not fully explore. In CHRp adolescents, the specificity of the psychotic transition –i.e. the ability to distinguish early psychotic symptoms from other developmental or psychiatric phenomena– is low.
The aim of this study is to illustrate the particularities of our Clinical High Risk of psychotic transition (CHRp) diagnostic outpatient clinic: Specialized Clinic for CHRp. The clinic is designed to improve the accuracy of identifying adolescents truly at risk of psychotic transition.
We present the case of a 14-year-old girl referred to our outpatient clinic with suspected CHRp. This clinical case describes the different phases of her evaluation: the CAARMS assessment, the neurodevelopmental and attachment history, the collaborative interview and the summary.
Combining adult psychiatry’s expertise in emerging psychosis with the child and adolescent psychiatrist’s specific knowledge of differential diagnoses and neurodevelopment at this age may enhance the accuracy of psychotic transition in CHRp adolescents.
Plain Language Summary
Adolescence is a period when changes in thoughts and emotions can sometimes look like early signs of psychosis, but most of these experiences are not the beginning of a psychotic disorder. This report presents the case of a 14-year-old girl evaluated for a possible risk of psychosis. Using both adult assessment tools and child psychiatry expertise, we highlight how understanding developmental history, attachment, and anxiety can help clinicians make more accurate evaluations. Our goal is to improve the accuracy of detecting true risk of psychosis in young people, while avoiding overdiagnosis.
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