Family history of a major psychotic disorder (such as schizophrenia, schizoaffective disorder, bipolar disorder, or depression with psychotic features) remains the single best predictor that a person will develop a psychotic disorder. Individuals with multiple affected family members are at even higher risk. That said, the vast majority of these individuals will NOT develop a psychotic disorder. Young people with a known family history of psychosis warrant careful monitoring for changes in either functioning or mental health. Screening and early detection of symptoms can help to identify those in need of specialized treatment early enough to prevent the suffering and disability that a relative may have experienced. Youth with a family history of major mental illness are likely to benefit from education about mental health and treatment options, and from support from others who have been in their shoes.
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* Distinguishing between substance-induced psychosis and a primary psychotic disorder can be challenging in young people. A careful review of the person’s symptoms along with a period of sustained abstinence is typically needed if symptoms do not quickly remit.
Asking about Family HistoryMany people may not know their family mental health history, but may have pieces of information that are relevant. To gather these pieces, we recommend asking several different questions. It is often helpful to get a list of all first and second degree relatives and have the patient think about all of them for each question. For any positive responses, ask the patient to tell you what they know of the person’s symptoms and ask specifically about hallucinations and unusual beliefs.
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Do you know of any family members who have:
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Young Children with Family History of PsychosisFor young children with a positive family history of psychotic symptoms or disorder, it is important to help caregivers consider options for enhancing general protective factors to support mental health (e.g., structure, warmth, open communication). The challenge is to help caregivers understand that the child is at higher risk for serious mental health issues without triggering unproductive anxiety or a sense that psychosis is inevitable. Families might take advantage of local chapter activities or resources of the National Alliance on Mental Illness (NAMI), or establish a relationship with a mental health clinician knowledgeable about both child development and serious mental illness who can provide education, support, and relevant intervention for mental health challenges if and as they emerge. Establishing a relationship in which the monitoring and addressing of mental health issues is a priority for the child’s healthcare is perhaps the most important task. |