EPICenter

The Early Psychosis Investigation Center (EPICenter) is dedicated to understanding, identifying and treating children and adolescents with psychotic disorders. We are a group of doctors, scientists, and clinicians at Boston Children’s Hospital (BCH) who are interested in understanding the factors that contribute to early onset psychosis. By focusing on early psychosis, at the EPICenter we hope to identify the root causes of the illness, improving treatment options and outcomes for patients and their families.

Who we are

The Early Psychosis Investigation Center (EPICenter) integrates clinical, translational and basic research with clinical care for children and adolescents with early (or very early) onset psychosis and their families. The center is designed to create a cohort of well characterized children and adolescents with early/very early onset psychosis and their family members with extensive phenotyping and available biological samples in order to facilitate discovery of the genetic and biological mechanisms that predispose psychotic illnesses.

Our goals

The EPICenter has four core tenets. First, we will work with children and adolescents with a psychotic disorder, regardless of diagnosis or comorbidity. Additionally, we include youths at high risk for psychosis due to a known genetic mutation (e.g. 22q11). Second, we are family focused so parents, siblings and more extended family are included in research and treatment. All EPICenter participants, including the proband, his or her parents, siblings and more distant relatives will receive an intake assessment. Third, we focus on longitudinal assessments. For the proband, this initial assessment will be followed by regular appointments to ensure treatment success, examine psychiatric symptoms over time, and provide additional phenotypic and biological data. Fourth, the EPICenter works closely with the Developmental Neuropsychiatry Clinic to seamlessly integrate research and clinical care. At the EPICenter, we envision a future where early detection and better treatment results in far fewer children, adolescents and young adults suffering from psychosis.

What is psychosis?

Early onset psychosis is a rare condition with poorly understood causes. To learn more about these disorders, we will study the genetic and environmental factors which may cause the development of psychosis. Genetic material, or DNA, is made up of many genes. Genes are passed down or “inherited” from parents to their children. They determine traits such as eye color, skin color, and how our bodies grow and develop. Genes can also determine whether someone develops certain medical conditions.

The typical onset for psychotic disorders is in late adolescence and young adulthood, yet approximately 20% of cases have their initial psychotic episode prior to age 18 (1). Early psychosis is typically defined as symptom onset before the age 18 (1, 2) and very early psychosis typically describes cases with onset before age 13 (3). Early/very early onset psychosis is viewed as a particularly severe form of the illness, as it is associated with poor premorbid function (4), greater number of hospitalizations (5), poorer cognitive function (6), structural and functional brain alterations (7), and high levels of comorbidity and poor long-term prognosis (8). Indeed, early psychosis is thought to represent the extreme end of a neuropathologic continuum (9-11). With the possible exception of children and adolescents who have suffered substantial trauma (12), early and very early onset psychosis is believed to occur among individuals with a significant genetic load for the disorder (13). By focusing on early and very early psychosis, the EPICenter hopes to contribute to the identification of the root causes of psychosis, improving treatment options and outcomes for patients and their families.