Scoping review of clinical high risk for psychosis and borderline personality disorder

Introduction: Clinical high risk for psychosis (CHR-P) and borderline personality disorder (BPD) often coexisist in clinical populations. This scoping review aims to systematically map existing research that simultaneously evaluates clinical high risk for psychosis (CHR-P) and borderline personality disorder (BPD) within clinical populations. Methods: PRISMA-ScR/JBI-compliant scoping review encompassing primary research studies—both cross-sectional and longitudinal studies—that used validated criteria/measures to assess both CHR-P and BPD, reporting on CHR-P/psychotic symptoms and personality disorder(s) in the title/abstract/keywords, detected in PubMed/Web of Science/(EBSCO)PsycINFO until 23/08/2023 (protocol: https://osf.io/8mz7a). Results: We included 33 studies, which were organized into four thematic categories: (i) BPD as a comorbidity in CHR-P youth (k = 20), focusing on early detection and intervention in psychosis; (ii) attenuated psychosis syndrome (APS) as a comorbidity among BPD inpatients (k = 2), emphasizing hospitalized adolescents/young adults admitted for non-psychotic mental disorders; (iii) mixed samples (k = 7), including detials on early intervention services; (iv) transdiagnostic approaches (k = 4) also including the “clinical high at risk mental state” (CHARMS) criteria to identify a pluripotent risk state for developing severe mental disorders. Conclusion: The scoping review identifies a variety of approaches to managing CHR-P and BPD in clinical settings, lacking a consistent treatment framework. Future research should prioritize: (i) examining referral pathways within early intervention clinics to ensure prompt treatment; (ii) improving early detection strategies in innovative settings like emergency departments; (iii) enhancing mental health literacy to support help-seeking behaviors; (iv) studying comorbid conditions as complex systems to enhance understanding and address early psychopathology; (v) assessing longitudinal risks associated with BPD; (vi) developing transdiagnostic treatment strategies; (vii) involving youth with lived experiences of comorbidity to explore their personal perspectives; (viii) assessing the burden of caregivers to develop interventions centered on family needs; (ix) broadening research efforts in regions like Africa and Asia that are less represented in current studies; and (x) analyzing the cost-effectiveness of early intervention programs to assess their potential for broader application internationally.