Professor Andrea Raballo’s editorial opens by posing a fundamental question: how good is our current ability to predict the risk of developing a serious mental illness? In response to the question, Professor Raballo presents an alternative perspective to the conventional one, which emphasises the search for biological indicators and genetic markers. He believes that currently, these factors are being overestimated in terms of their ability to predict and clinically validate certain conditions. To support his argument, Raballo uses the example of schizophrenia, stating that "the transgenerational transmission of the risk of schizophrenia extends beyond the presumed genetic contribution" and includes early relational, familial, and environmental aspects. Early diagnosis of psychosis, as well as attempts to prevent it, are currently based on the recognition of so-called "high clinical risk of psychosis" (CHR-P) conditions, from which the DSM-5 diagnostic category "attenuated psychosis syndrome" is also derived. However, not all patients with schizophrenia manifest the symptoms defined by the CHR-P criteria. The USI professor also reminds us that it is good to keep in mind that psychotic symptoms manifested during adolescence are only the tip of the iceberg. "What lies beneath the surface, although less visible, is more extensive and includes the gradual accumulation of delays and difficulties in cognitive, motor, and social-interpersonal domains. These challenges interact and have a cumulative effect, beginning in childhood and continuing throughout the developmental years. This may worsen during puberty due to the increased complexity of social dynamics and changes in the brain and body." Playing a significant role in the gradual buildup of these risk factors could be neurodevelopmental abnormalities associated with changes in sensorimotor integration, motor coordination, and the ability to differentiate between self-generated and externally generated actions, leading to the emergence of distressing subjective experiences.
In light of these considerations, Professor Raballo emphasises the central importance of services dedicated to the mental health of children and adolescents as a pivotal place for both possible prevention and early detection of the risk of subsequent onset of severe mental illness. "A balanced assessment of the current evidence can help redirect early efforts on detecting risks, taking advantage of information gathered from the premorbid stages of childhood to the prodromal stages of adolescence. Indeed, early prodromal psycho-behavioural manifestations, which are linked to a higher risk of severe mental illness later in life, typically emerge during childhood and adolescence. Moreover, it is increasingly recognised that the symptoms, traits and psychopathological disorders observed in adolescence and early adulthood often stem from a neurodevelopmental alteration, already evident in childhood through neurocognitive and behavioural abnormalities".
Professor Raballo emphasizes that while the example mentioned in the editorial primarily relates to schizophrenia, a similar argument could also be applied to other conditions.
