Age of onset of mental disorders and use of mental health services: Needs, opportunities and obstacles

IRCCS Fatebenefratelli, Via Pilastroni 4, 25125 Brescia, Italy.
Epidemiology and Psychiatric Sciences (Impact Factor: 3.91). 03/2012; 21(1):47-57. DOI: 10.1017/S2045796011000746
Source: PubMed


In this review, we provide an update of recent studies on the age of onset (AOO) of the major mental disorders, with a special focus on the availability and use of services providing prevention and early intervention.
The studies reviewed here confirm previous reports on the AOO of the major mental disorders. Although the behaviour disorders and specific anxiety disorders emerge during childhood, most of the high-prevalence disorders (mood, anxiety and substance use) emerge during adolescence and early adulthood, as do the psychotic disorders. Early AOO has been shown to be associated with a longer duration of untreated illness, and poorer clinical and functional outcomes.
Although the onset of most mental disorders usually occurs during the first three decades of life, effective treatment is typically not initiated until a number of years later. There is increasing evidence that intervention during the early stages of disorder may help reduce the severity and/or the persistence of the initial or primary disorder, and prevent secondary disorders. However, additional research is needed on effective interventions in early-stage cases, as well as on the long-term effects of early intervention, and for an appropriate service design for those with emerging mental disorders. This will mean not only the strengthening and re-engineering of existing systems, but is also crucial the construction of new streams of care for young people in transition to adulthood.

Download full-text


Available from: Angelo Cocchi, Apr 17, 2015
  • Source
    • "The lifetime prevalence of psychoses is estimated between 0.2 and 3.5% [83] [125], their annual incidence between 0.01 and 0.035%, with growing numbers reported in Europe where, within 12 months, approximately 3.7 million adults (0.8%) had been affected in 2005 and as much as 5 million (1.2%) in 2011 [46] [125]. The gender related incidence of affective and non-affective psychotic disorders depends on type of psychosis and age with a higher incidence of schizophrenia in men and a similar cumulative incidence of all psychoses at age 60 [19] [34] [35] [38] [47] [65] [114]. Approximately 10–15% of all psychoses are early-onset psychoses (EOP) manifesting before the age of 18, and approximately 1–3% are very-early-onset psychoses (VEOP) with an onset before the age of 13 [98] [125]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion 'cognitive disturbances' (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The 'genetic risk and functional decline' UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    European Psychiatry 03/2015; 30:405-416. DOI:10.1016/j.eurpsy.2015.01.010 · 3.44 Impact Factor
  • Source
    • "The majority of mental disorders emerge in adolescence and young adulthood (Belfer 2008; de Girolamo et al. 2012), with three-quarters of all lifetime cases occurring before 24 years of age (Kessler et al. 2005). Mental health problems in young people significantly impact on their social, emotional, physical, and educational development (Kazdin 1993; Strauss et al. 1987), and are likely to continue well into adulthood if left untreated (Catania et al. 2011; de Girolamo et al. 2012). Fortunately, early intervention and prevention strategies can substantially improve the outlook (McGorry et al. 2011) but, in order for mental health professionals to provide appropriate intervention, assessments that give an accurate and holistic picture of the young person and their life are required (Leavey et al. 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: For mental health professionals to provide personalized early interventions, young people need to disclose sensitive information to a clinician they are unlikely to have yet formed a relationship with. We conducted in-depth qualitative interviews with 129 young people aged 12–25 years from several sites across Australia to gauge views on whether young people thought that an electronic psychosocial assessment tool could help them initially disclose personal information. Additionally, we were interested in whether young people from different demographic groups held similar views around using the e-tool. Results provided support for the use of an e-tool, with most young people stating that it could help in the disclosure of particularly embarrassing problems. The main advantages reported were that the e-tool would support disclosure without fear of judgment by health professionals, and would enable young people greater input in deciding what to focus on. Young people who held a preference to simply talk were most concerned about the clinician missing non-verbal cues. These findings highlight the value of incorporating electronic options within clinical practice, but also the need for health professionals to work within a flexible framework guided by the individual preferences of each of their clients.
    Journal of Child and Family Studies 05/2014; 24(5). DOI:10.1007/s10826-014-9929-0 · 1.42 Impact Factor
  • Source
    • "Thus, whilst early psychosis services primarily set out to identify patients at risk for psychosis as early as possible in the disease course, they now more commonly face the additional task of disentangling genuine psychotic risk states from other overlapping psychiatric diagnoses. This task is all the more challenging as not only psychosis, but also most other mental illnesses begin in adolescence [6]. Furthermore, as adolescence is a period of life characterized by multitudinous variants in behaviour, developing diversity of contextual thinking, and frequent emotional turmoil, patients that are referred to early psychosis services for risk assessment may simply experience symptoms that belong to the large scope of phenomena inhering in adolescence. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To discuss the diagnostic validity of unusual bodily perceptions along the spectrum from age-specific, often transitory and normal, to pathological phenomena in adolescence to hypochondriasis and finally to psychosis. Methods Critical literature review of the cornerstone diagnostic groups along the spectrum embracing anxiety and cenesthopathy in adolescence, hypochondriasis, and cenesthopathy and psychosis, followed by a discussion of the diagnostic overlaps along this spectrum. Results The review highlights significant overlaps between the diagnostic cornerstones. It is apparent that adolescents with unusual bodily perceptions may conceptually qualify for more than one diagnostic group along the spectrum. To determine whether cenesthopathies in adolescence mirror emerging psychosis, a number of issues need to be considered, i.e. age and mode of onset, gender, level of functioning and drug use. The role of overvalued ideas at the border between hypochondriasis and psychosis must be considered. Conclusion As unusual bodily symptoms may in some instances meet formal psychosis risk criteria, a narrow understanding of these symptoms may lead to both inappropriate application of the new DSM-5 attenuated psychosis syndrome and of treatment selection. On the other hand, the possibility of a psychotic dimension of unusual bodily symptoms in adolescents must always be considered as most severe expression of the cenesthopathy spectrum.
    Comprehensive psychiatry 02/2014; DOI:10.1016/j.comppsych.2014.02.007 · 2.25 Impact Factor
Show more