Constitution, illness, and family in persistent personality change: proposal of a longitudinal clinical model
DOI:
https://doi.org/10.25118/2763-9037.2026.v16.1681Keywords:
psychosis, personality disorders, family relations, first-episode psychosis, prognosisAbstract
Introduction: Distinguishing personality traits from psychotic symptoms and persistent changes following psychiatric illness represents a clinically relevant challenge, given the phenomenological overlap among these domains and the complexity of the longitudinal course of mental disorders. Objective: To critically present and discuss an integrative clinical model linking constitution, illness, clinical fluctuations, family dynamics, and persistent personality changes. Methods: A critical narrative review of recent literature addressing personality and psychosis, first-episode psychosis, longitudinal illness trajectories, family functioning, and the clinical recognition of persistent changes was conducted, following the criteria of the SANRA (Scale for the Assessment of Narrative Review Articles) scale. Results: Recent studies have demonstrated associations between personality dimensions and clinically relevant outcomes, including symptom severity, global functioning, treatment adherence, recovery, and healthcare utilization. Reviews have also identified relationships between family-related factors, relapse, symptom expression, caregiver burden, and psychosocial functioning. Collectively, these findings support the value of a longitudinal and multidimensional assessment, although they do not directly validate the specific terminology or conceptual structure proposed by the model. Conclusion: The model may be used as an integrative, hypothesis-generating clinical framework, provided that its concepts are operationally defined, clearly distinguished from formal psychiatric diagnoses, and subjected to prospective studies assessing its validity, reliability, and clinical utility.
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1. Albin K, Albin C, Jeffries CD, Perkins DO. Clinician recognition of first episode psychosis. J Adolesc Health. 2021;69(3):457-64. https://doi.org/10.1016/j.jadohealth.2020.12.138 PMid:33846053 PMCid:PMC11839206
2. Prakash J, Saini RK, Srivastava K, Chatterjee K, Basannar DR, Mohan P. Longitudinal study of the course and outcome of first-episode psychosis. Med J Armed Forces India. 2023;79(5):539-46. https://doi.org/10.1016/j.mjafi.2021.04.013 PMid:37719902 PMCid:PMC10499655
3. Rodrigues GA, Castanheira FM Jr, Caixeta MF. The general psychiatric syndrome as a transdiagnostic hypothesis: a critical appraisal of evidence, interpretation and clinical reach. Int Neuropsychiatr Dis J. 2026;23(5):67-88. https://doi.org/10.9734/indj/2026/v23i5581
4. Rodrigues GA, Castanheira FM Jr, Caixeta MF. Doença psiquiátrica geral: um marco nosográfico unificador para a psiquiatria com aplicações em psicopatologia, farmacologia, psicoterapia e cognição. Debates Psiquiatr. 16:1-25, e1633. https://doi.org/10.25118/2763-9037.2026.v16.1633
5. Jarema M. Schizophrenia plus-comorbidity of schizophrenia and personality disorders: clinician's reflections. Psychiatr Pol. 2022;56(6):1153-64. https://doi.org/10.12740/PP/144112 PMid:37098191
6. Biancalani A, Pelizza L, Menchetti M. Borderline personality disorder and early psychosis: a narrative review. Ann Gen Psychiatry. 2023;22(1):44. https://doi.org/10.1186/s12991-023-00475-w PMid:37919718 PMCid:PMC10623785
7. Ottesen A, Hegelstad TV, Joa I, Opjordsmoen S, Rund BR, Røssberg JI, Simonsen E, Johannessen JO, Larsen TK, Haahr UH, McGlashan TH, Friis S, Melle I. Childhood trauma, antipsychotic medication, and symptom remission in first-episode psychosis. Psychol Med. 2023;53(6):2399-2408. https://doi.org/10.1017/S003329172100427X PMid:37144963 PMCid:PMC10123824
8. Yelmo-Cruz S, Morera-Fumero AL, Lakhwani S, Abreu-González P. Brain-Derived Neurotrophic Factor (BDNF) and First-Episode Psychosis. A longitudinal one-year prognosis study. Actas Esp Psiquiatr. 2023;51(3):130-140. https://pubmed.ncbi.nlm.nih.gov/37489557/ PMID: 37489557; PMCID: PMC10803868.
9. Leendertse P, van den Berg D, Castelein S, Mulder CL. Does personality moderate the association between social involvement and personal recovery in psychosis? BMC Psychiatry. 2024;24(1):958. https://doi.org/10.1186/s12888-024-06372-0 PMid:39731057 PMCid:PMC11681711
10. Scala M, Gori D, Roca P, Fabbri C, Arroyo Iturra R, Calvo García SF, Fanelli G, Serretti A. Personality domains in early stages of psychosis: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2026;276:1111-26. https://doi.org/10.1007/s00406-025-02127-4 PMid:41222667 PMCid:PMC13002659
11. Jang YJ, Yassin W, Mesholam-Gately R, Gershon ES, Keedy S, Pearlson GG, Tamminga CA, McDowell J, Parker DA, Sauer K, Keshavan MS. Characterizing the relationship between personality dimensions and psychosis-specific clinical characteristics. Schizophr Res. 2025;276:88-96. https://doi.org/10.1016/j.schres.2025.01.002 PMid:39864301 PMCid:PMC13266951
12. Longenecker JM, Haas GL, Salisbury DF. Hierarchical symptom components in early psychosis. Schizophr Bull. 2022;48(4):893-901. https://doi.org/10.1093/schbul/sbac048 PMid:35639737 PMCid:PMC9212103
13. Jørgensen MS, Austin SF, Storebø OJ, Poulsen S, Bo S, Beck E, Simonsen E. Borderline personality disorder or first-episode psychosis? Challenges in assessing psychotic features in early intervention: a case report. Early Interv Psychiatry. 2025;19(10):e70103. https://doi.org/10.1111/eip.70103 PMid:41036689 PMCid:PMC12489974
14. Salazar de Pablo G, Guinart D, Armendariz A, Aymerich C, Catalan A, Alameda L, Rogdaki M, Baringo EM, Soler-Vidal J, Oliver D, Rubio JM, Arango C, Kane JM, Fusar-Poli P, Correll CU. Duration of untreated psychosis and outcomes in first-episode psychosis: systematic review and meta-analysis of early detection and intervention strategies. Schizophr Bull. 2024;50(4):771-83. https://doi.org/10.1093/schbul/sbae017 PMid:38491933 PMCid:PMC11283197
15. Crespo-Facorro B, Fernandez-Egea E. Revisiting first-episode psychosis and schizophrenia through a multidimensional and longitudinal lens. Span J Psychiatry Ment Health. 2025;18(2):65-6. https://doi.org/10.1016/j.sjpmh.2025.06.001 PMid:40582728
16. Mantonakis L, Stefanatou P, Tsionis A, Konstantakopoulos G, Xenaki LA, Ntigrintaki AA, Ralli I, Dimitrakopoulos S, Kollias K, Stefanis NC. Cognitive inflexibility predicts negative symptoms severity in patients with first-episode psychosis: a 1-year follow-up study. Brain Sci. 2024;14(2):162. https://doi.org/10.3390/brainsci14020162 PMid:38391736 PMCid:PMC10886606
17. Lee M, Cullen AE, Matheson GJ, Lu ZA, Bergen SE, Sellgren CM, Erhardt S, Fatouros-Bergman H, Cervenka S. Cognition before and after psychosis onset: a naturalistic study of change, heterogeneity, and prognosis. Schizophr Res Cogn. 2025;42:100387. https://doi.org/10.1016/j.scog.2025.100387 PMid:40933840 PMCid:PMC12419124
18. Sicotte R, D'Andrea G, Dumais A, Crocker AG, Villeneuve M, Brochu E, Abdel-Baki A. Aggressive behaviors in first-episode psychosis: distinction between the premorbid phase and the onset of psychosis. Schizophr Res. 2024;271:283-91. https://doi.org/10.1016/j.schres.2024.07.033 PMid:39079405
19. Keegan C, Brown K, Gaynor K. A systematic review exploring the relationship between family factors and symptom severity, relapse and social or occupational functioning in first-episode psychosis. Early Interv Psychiatry. 2025;19(3):e13643. https://doi.org/10.1111/eip.13643 PMid:39779465 PMCid:PMC11904263
20. Fahrer JF, Dobener LM, Asbrand J, Christiansen H. Expressed emotion in the family: a meta-analytic review of expressed emotion as a mechanism of the transgenerational transmission of mental disorders. Front Psychiatry. 2022;12:721796. https://doi.org/10.3389/fpsyt.2021.721796 PMid:35177995 PMCid:PMC8846301
21. Espinosa V, Arin-González P, Jiménez-Lafuente A, Pardo N, López-Carrilero R, Birulés I, Barajas A, Pélaez T, Díaz-Cutraro L, Verdaguer-Rodríguez M, Gutiérrez-Zotes A, Palma-Sevillano C, Varela-Casals P, Salas-Sender M, Aznar A, Ayesa-Arriola R, Pousa E, Canal-Rivero M, Garrido-Torres N, Montserrat C, Muñoz-Lorenzo L, Crosas JM, Ochoa S. Family metacognitive training (MCT-F): adapting MCT to mothers with psychosis and their adolescent children. Behav Sci (Basel). 2024;14(2):97. https://doi.org/10.3390/bs14020097 PMid:38392450 PMCid:PMC10885955
22. Gouveia M, Morgado T, Costa T, Sampaio F, Rosa A, Sequeira C. Intervention programmes for first-episode psychosis: a scoping review. Nurs Rep (Pavia). 2025;15(1). https://doi.org/10.3390/nursrep15010016 PMid:39852638 PMCid:PMC11767625
23. Florence AC, Stefančić A, Sheitman A, Fidaleo K, Bello I, Dixon L, Drake RE, Nossel I, Cabassa LJ, Montague E, Pagdon S, Lyn J, Patel SR. Client and family experiences with telehealth-delivered early psychosis services. Early Interv Psychiatry. 2024;18(12):1032-39. https://doi.org/10.1111/eip.13550 PMid:38945691 PMCid:PMC11625533
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Copyright (c) 2026 Giovanna Azevedo Rodrigues, Fernando Martins Castanheira Júnior, Marcelo Caixeta
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