Mentalizing Across the Psychosis Continuum in Adolescence and Young Adulthood: A Systematic Review and Narrative Synthesis.

Background and hypothesis: Mentalizing difficulties have consistently been identified in adult samples across the psychosis continuum. However, the links between mentalizing and psychosis expression during the critical period spanning from adolescence to young adulthood, when the earliest signs of psychosis commonly emerge, remain less clear. The current review aims to synthesize and evaluate existing findings on the presence and role of mentalizing dysfunction at each stage of the psychosis continuum in adolescent and young adult samples.

Study design: Electronic databases were used to identify empirical articles examining the links between mentalizing and psychosis expression in community, clinical-high risk for psychosis (CHR-P), first episode psychosis (FEP), and clinical psychosis samples aged 10-25 years. A narrative synthesis approach was used to integrate and evaluate the study findings.

Results: Twenty-six eligible studies were identified with a combined sample of 4391 individuals. The synthesis of findings indicates mixed evidence on the links between mentalizing and nonclinical psychotic manifestations in community samples. Most studies with CHR-P samples suggest that mentalizing difficulties are present during the psychosis prodrome and may contribute to its clinical progression. Studies among adolescents and young adults with FEP and those with a previous diagnosis of psychotic disorders indicate that mentalizing impairments are present at the point of conversion and early course of the illness.

Conclusions: The findings of the review suggest that mentalizing difficulties can be observed across the psychosis continuum in adolescence and young adulthood, particularly during the prodromal and clinical stages and may constitute valid early intervention targets.