Harmonizing early intervention strategies: scoping review of clinical high risk for psychosis and borderline personality disorder

Gabriele Lo Buglio; Tommaso Boldrini; Andrea Polari; Flavia Fiorentino; Barnaby Nelson; Marco Solmi; Vittorio Lingiardi; Annalisa Tanzilli

doi:10.3389/fpsyg.2024.1381864

Harmonizing early intervention strategies: scoping review of clinical high risk for psychosis and borderline personality disorder

Front Psychol. 2024 Jun 20:15:1381864. doi: 10.3389/fpsyg.2024.1381864. eCollection 2024.

Authors

Gabriele Lo Buglio¹, Tommaso Boldrini², Andrea Polari^{3

4}, Flavia Fiorentino¹, Barnaby Nelson^{4

5}, Marco Solmi^{6

7

8

9

10}, Vittorio Lingiardi¹, Annalisa Tanzilli¹

Affiliations

¹ Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
² Department of Psychology and Educational Science, Pegaso Telematic University, Naples, Italy.
³ Orygen Specialist Programs, Melbourne, VIC, Australia.
⁴ Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
⁵ Orygen, Parkville, VIC, Australia.
⁶ Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
⁷ On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.
⁸ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
⁹ Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
¹⁰ Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Abstract

Aims: To map studies assessing both clinical high risk for psychosis (CHR-P) and borderline personality disorder (BPD) in clinical samples, focusing on clinical/research/preventive paradigms and proposing informed research recommendations.

Methods: We conducted a PRISMA-ScR/JBI-compliant scoping review (protocol: https://osf.io/8mz7a) of primary research studies (cross-sectional/longitudinal designs) using valid measures/criteria to assess CHR-P and BPD (threshold/subthreshold) in clinical samples, reporting on CHR-P/psychotic symptoms and personality disorder(s) in the title/abstract/keywords, identified in Web of Science/PubMed/(EBSCO)PsycINFO until 23/08/2023.

Results: 33 studies were included and categorized into four themes reflecting their respective clinical/research/preventive paradigm: (i) BPD as a comorbidity in CHR-P youth (k = 20), emphasizing early detection and intervention in psychosis; (ii) attenuated psychosis syndrome (APS) as a comorbidity among BPD inpatients (k = 2), with a focus on hospitalized adolescents/young adults admitted for non-psychotic mental disorders; (iii) mixed samples (k = 7), including descriptions of early intervention services and referral pathways; (iv) transdiagnostic approaches (k = 4) highlighting "clinical high at risk mental state" (CHARMS) criteria to identify a pluripotent risk state for severe mental disorders.

Conclusion: The scoping review reveals diverse approaches to clinical care for CHR-P and BPD, with no unified treatment strategies. Recommendations for future research should focus on: (i) exploring referral pathways across early intervention clinics to promote timely intervention; (ii) enhancing early detection strategies in innovative settings such as emergency departments; (iii) improving mental health literacy to facilitate help-seeking behaviors; (iv) analysing comorbid disorders as complex systems to better understand and target early psychopathology; (v) investigating prospective risk for BPD; (vi) developing transdiagnostic interventions; (vii) engaging youth with lived experience of comorbidity to gain insight on their subjective experience; (viii) understanding caregiver burden to craft family-focused interventions; (ix) expanding research in underrepresented regions such as Africa and Asia, and; (x) evaluating the cost-effectiveness of early interventions to determine scalability across different countries.

Systematic review registration: https://osf.io/8mz7a.

Keywords: borderline personality disorder; clinical high risk for psychosis; comorbidity; early intervention; psychosis; scoping review; transdiagnostic approach.

Publication types

Systematic Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This open access of this research was supported by funding from the Ministry of University and Research under the call Progetti di Rilevante Interesse Nazionale (PRIN) 2022 (project number 20224SX547; Principal Investigator: Giacomo Ciocca; Associated Investigator: TB) awarded to Giacomo Ciocca and TB.