Bullying in individuals at ultra-high risk for psychosis

Background. - Bullying in schools during childhood and adolescence is a growing public health problem due to its high prevalence worldwide and its various negative impacts on mental health. Evidence suggests that the ''ultra-high risk for psychosis'' (UHR) state is associated with a higher prevalence of bullying compared to the control subjects. We proposed to summarize the results of existing studies to provide a more thorough understanding of the mechanisms linking bullying and an UHR state, their clinical and evolutionary specificities, as well as their interventional implications. Method. - PubMed and Medline search, Scopus, journal and textbook articles have been consulted for the review of literature on the relationship between bullying and psychosis in UHR subjects. Results. - We found that the type of bullying experienced during childhood and adolescence may be related to the nature of subclinical psychotic symptoms experienced later. The development of psychotic symptoms in victims of bullying appears to be related to the frequency, severity, and duration of victimization. Limited evidence suggests that stopping bullying may prevent the onset of psychotic symptoms or an UHR state. Several explanatory models of the link between bullying and the subsequent onset of psychosis or prepsychotic states have been advanced in the literature, including premorbid developmental abnormalities, quality of attachment, dysfunctional cognitive patterns and theory of mind, and hypothalamic-pituitary axis abnormalities. Conclusion. - Despite the limited body of evidence, screening for the existence of prior victimization during the initial assessment of UHR subjects and their adequate management seem to be justified. However, to date, no study has evaluated specific intervention protocols for the management of bullying in UHR subjects.