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image of Relevance of Clinical High-Risk of Psychotic Transition Concept to Avoid Misdiagnosis Risk in an Unaccompanied Minor Refugee with Complex Trauma: A Case Report

Abstract

Introduction

Unaccompanied refugee minors face a heightened risk of mental health disorders due to cumulative traumatic exposures and sociocultural displacement. Psychotic-like symptoms are common and frequently misdiagnosed as primary psychotic disorders, often overlooking trauma-related or culturally-influenced presentations.

Case Presentation

We report the case of “Moussa”, a 15-year-old URM from Cameroon, who presented with transient psychotic symptoms during an acute stress episode. Following the CAARMS assessment, he was initially diagnosed with a Clinical High-Risk for psychosis state (CHRp), then later labeled as schizophreniform by another provider. However, his rapid remission and trauma history led to a revised diagnosis of complex PTSD.

Conclusion

This case underscores the risks of early psychiatric labeling in traumatized migrant youth. Greater use of CHRp frameworks—if combined with cultural and ethical caution—may help delay premature diagnoses and favor tailored care. However, the CHRp construct itself remains debated, and its application should not obscure broader systemic biases. Main limitations include the single-case design and the absence of standardized trauma assessments. Therefore, longitudinal research is needed.

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2026-01-02
2026-01-09

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References

  1. Adebimpe V.R. Overview: white norms and psychiatric diagnosis of black patients. The American Journal of Psychiatry 1981 138 3 279 285 10.1176/ajp.138.3.279 7008631
    [Google Scholar]
  2. Andersson E.S. Øverlien C. Navigating cultural transitions during resettlement: the case of unaccompanied refugee minors. Frontiers in Psychology. 2023 14 1080072 10.3389/fpsyg.2023.1080072 37228345
    [Google Scholar]
  3. Angel R. Thoits P. The impact of culture on the cognitive structure of illness. Culture, Medicine, and Psychiatry 1987 11 4 465 494 10.1007/BF00048494 3319427
    [Google Scholar]
  4. Barnes A. Race and hospital diagnoses of schizophrenia and mood disorders. Social Work 2008 53 1 77 83 10.1093/sw/53.1.77 18610823
    [Google Scholar]
  5. Baubet T. Taïeb O. Guillaume J. Moro M.R. Psychotic states in young migrants and children of migrants. L'Encéphale 2009 35 S219 S223 10.1016/S0013‑7006(09)73474‑8 20141775
    [Google Scholar]
  6. Bhui K.S. Owiti J.A. Palinski A. Ascoli M. De Jongh B. Archer J. Staples P. Ahmed N. Ajaz A. A cultural consultation service in East London: Experiences and outcomes from implementation of an innovative service. International Review of Psychiatry 2015 27 1 11 22 10.3109/09540261.2014.992303 25747024
    [Google Scholar]
  7. Cantor-Graae E. Selten J.P. Schizophrenia and migration: A meta-analysis and review. The American Journal of Psychiatry 2005 162 1 12 24 10.1176/appi.ajp.162.1.12 15625195
    [Google Scholar]
  8. Davidson J.R.T. Long-term treatment and prevention of posttraumatic stress disorder. The Journal of Clinical Psychiatry 2004 65 44 48 14728096
    [Google Scholar]
  9. Derluyn I. Broekaert E. Different perspectives on emotional and behavioural problems in unaccompanied refugee children and adolescents. Ethnicity Health 2007 12 2 141 162 10.1080/13557850601002296 17364899
    [Google Scholar]
  10. Devereux G. 1980 Basic problems of ethnopsychiatry. Thesis University of Chicago Press.
    [Google Scholar]
  11. Fusar-Poli P. Borgwardt S. Bechdolf A. Addington J. Riecher-Rössler A. Schultze-Lutter F. Keshavan M. Wood S. Ruhrmann S. Seidman L.J. Valmaggia L. Cannon T. Velthorst E. De Haan L. Cornblatt B. Bonoldi I. Birchwood M. McGlashan T. Carpenter W. McGorry P. Klosterkötter J. McGuire P. Yung A. The psychosis high-risk state: A comprehensive state-of-the-art review. JAMA Psychiatry 2013 70 1 107 120 10.1001/jamapsychiatry.2013.269 23165428
    [Google Scholar]
  12. Gaw A. Culture, ethnicity, and mental illness. American Psychiatric Press 1993
    [Google Scholar]
  13. Gouriou F. The two faces of the symptom: Epistemological remarks on the ethnopsychiatry of. Recherches en Psychanalyse 2012 14 2 206a 10.3917/rep.014.0206a
    [Google Scholar]
  14. Hodes M. Psychologically distressed refugee children in the United Kingdom. Child Adolesc. Ment. Health 2000 5 2 57 68 10.1111/1475‑3588.00286
    [Google Scholar]
  15. Huemer J. Karnik N.S. Voelkl-Kernstock S. Granditsch E. Dervic K. Friedrich M.H. Steiner H. Mental health issues in unaccompanied refugee minors. Child and Adolescent. Mental Health 2009 3 1 13 10.1186/1753‑2000‑3‑13 19341468
    [Google Scholar]
  16. Jarvis G.E. Kirmayer L.J. Gómez-Carrillo A. Aggarwal N.K. Lewis-Fernández R. Update on the cultural formulation interview. Focus: American. Psychiatric. Publishing 2020 18 1 40 46 10.1176/appi.focus.20190037 32047396
    [Google Scholar]
  17. Jaycox L.H. Stein B.D. Kataoka S.H. Wong M. Fink A. Escudero P. Zaragoza C. Violence exposure, posttraumatic stress disorder, and depressive symptoms among recent immigrant schoolchildren. Journal of the American Academy of Child and Adolescent Psychiatry 2002 41 9 1104 1110 10.1097/00004583‑200209000‑00011 12218432
    [Google Scholar]
  18. Kleinman A.M. Depression, somatization and the new cross-cultural psychiatry. Social. Science Medicine 1977 11 1 3 10 10.1016/0037‑7856(77)90138‑X
    [Google Scholar]
  19. Krebs M.O. Magaud E. Willard D. Elkhazen C. Chauchot F. Gut A. Morvan Y. Bourdel M.C. Kazes M. Assessment of mental states at risk of psychotic transition: Validation of the French version of the CAARMS. L'Encéphale 2014 40 6 447 456 10.1016/j.encep.2013.12.003 25127895
    [Google Scholar]
  20. Lachal J. Escaich M. Bouznah S. Rousselle C. De Lonlay P. Canoui P. Moro M.R. Durand-Zaleski I. Transcultural mediation programme in a paediatric hospital in France: Qualitative and quantitative study of participants’ experience and impact on hospital costs. BMJ Open 2019 9 11 e032498 10.1136/bmjopen‑2019‑032498 31753892
    [Google Scholar]
  21. Lambert H. International Refugee Law. (1st éd). Routledge. 2017
    [Google Scholar]
  22. Maioli S.C. Bhabha J. Wickramage K. Wood L.C.N. Erragne L. Ortega García O. Burgess R. Digidiki V. Aldridge R.W. Devakumar D. International migration of unaccompanied minors: Trends, health risks, and legal protection. Lancet Child Adolesc. Health 2021 5 12 882 895 10.1016/S2352‑4642(21)00194‑2 34416189
    [Google Scholar]
  23. McGorry P.D. Bell R.C. Dudgeon P.L. Jackson H.J. The dimensional structure of first episode psychosis: An exploratory factor analysis. Psychological Medicine 1998 28 4 935 947 10.1017/S0033291798006771 9723148
    [Google Scholar]
  24. McGorry P.D. Edwards J. Mihalopoulos C. Harrigan S.M. Jackson H.J. EPPIC: An evolving system of early detection and optimal management. Schizophrenia. Bulletin. 1996 22 2 305 326 10.1093/schbul/22.2.305 8782288
    [Google Scholar]
  25. McGorry P.D. Killackey E. Yung A.R. Early intervention in psychotic disorders: Detection and treatment of the first episode and the critical early stages. The Medical Journal of Australia 2007 187 S7 S8 S10 10.5694/j.1326‑5377.2007.tb01327.x 17908033
    [Google Scholar]
  26. Meesters P.D. Comijs H.C. de Haan L. Smit J.H. Eikelenboom P. Beekman A.T.F. Stek M.L. Subjective quality of life and its determinants in a catchment area based population of elderly schizophrenia patients. Schizophrenia Research 2013 147 2-3 275 280 10.1016/j.schres.2013.04.030 23693066
    [Google Scholar]
  27. Milot T. Complex trauma: Understanding, assessing and intervening. Thesis University of Quebec Press. 2018
    [Google Scholar]
  28. Moore D. Castagnini E. Mifsud N. Geros H. Sizer H. Addington J. van der Gaag M. Nelson B. McGorry P. O’Donoghue B. The associations between migrant status and ethnicity and the identification of individuals at ultra-high risk for psychosis and transition to psychosis: A systematic review. Social. Psychiatry and Psychiatric. Epidemiology. 2021 56 11 1923 1941 10.1007/s00127‑021‑02047‑3 33641006
    [Google Scholar]
  29. Mukherjee S. Shukla S. Woodle J. Rosen A.M. Olarte S. Misdiagnosis of schizophrenia in bipolar patients: A multiethnic comparison. The American Journal of Psychiatry 1983 140 12 1571 1574 10.1176/ajp.140.12.1571 6650685
    [Google Scholar]
  30. Newcomer J.W. Haupt D.W. Fucetola R. Melson A.K. Schweiger J.A. Cooper B.P. Selke G. Abnormalities in glucose regulation during antipsychotic treatment of schizophrenia. Archives of General Psychiatry 2002 59 4 337 345 10.1001/archpsyc.59.4.337 11926934
    [Google Scholar]
  31. Oberg C. Sharma H. Post-Traumatic stress disorder in unaccompanied refugee minors: Prevalence, contributing and protective factors, and effective interventions: A scoping review. Children 2023 10 6 941 10.3390/children10060941 37371174
    [Google Scholar]
  32. O’Donoghue B. Geros H. Sizer H. Addington J. Amminger G.P. Beaden C.E. Cadenhead K.S. Cannon T.D. Cornblatt B.A. Berger G.E. Chen E.Y.H. de Haan L. Hartmann J.A. Hickie I.B. Ising H.K. Lavoie S. Lin A. Markulev C. Mathalon D.H. McGlashan T.H. Mifsud N.G. Mossaheb N. Nieman D.H. Nordentoft M. Perkins D.O. Riecher-Rössler A. Schäfer M.R. Schlögelhofer M. Seidman L.J. Smesny S. Thompson A. Tsuang M.T. van der Gaag M. Verma S. Walker E.F. Wood S.J. Woods S.W. Yuen H.P. Yung A.R. McGorry P.D. Nelson B. The association between migrant status and transition in an ultra-high risk for psychosis population. Social. Psychiatry and Psychiatric. Epidemiology 2021 56 6 943 952 10.1007/s00127‑020‑02012‑6 33399885
    [Google Scholar]
  33. O’Donoghue B. Polari A. McGorry P. Nelson B. Young migrants to Australia identified as being at ultra-high risk for psychosis: Pathways to care and clinical characteristics. Schizophrenia Research, 2022 241 156 160 10.1016/j.schres.2022.01.036 35124434
    [Google Scholar]
  34. Owiti J.A. Ajaz A. Ascoli M. de Jongh B. Palinski A. Bhui K.S. Cultural consultation as a model for training multidisciplinary mental healthcare professionals in cultural competence skills: Preliminary results. Journal of. Psychiatric and . Mental. Health Nursing. 2014 21 9 814 826 10.1111/jpm.12124 24279693
    [Google Scholar]
  35. Perry B.I. Upthegrove R. Crawford O. Jang S. Lau E. McGill I. Carver E. Jones P.B. Khandaker G.M. Cardiometabolic risk prediction algorithms for young people with psychosis: A systematic review and exploratory analysis. Acta Psychiatrica Scandinavica 2020 142 3 215 232 10.1111/acps.13212 32654119
    [Google Scholar]
  36. Pfeiffer E. Behrendt M. Adeyinka S. Devlieger I. Rota M. Uzureau O. Verhaeghe F. Lietaert I. Derluyn I. Traumatic events, daily stressors and posttraumatic stress in unaccompanied young refugees during their flight: A longitudinal cross-country study. Child and Adolescent. Psychiatry and Mental. Health 2022 16 1 26 10.1186/s13034‑022‑00461‑2 35361239
    [Google Scholar]
  37. Ramel B. Täljemark J. Lindgren A. Johansson B.A. Overrepresentation of unaccompanied refugee minors in inpatient psychiatric care. Springerplus 2015 4 1 131 10.1186/s40064‑015‑0902‑1 25825687
    [Google Scholar]
  38. Saccaro L.F. Aimo A. Panichella G. Sentissi O. Shared and unique characteristics of metabolic syndrome in psychotic disorders: a review. Frontiers in. Psychiatry 2024 15 1343427 10.3389/fpsyt.2024.1343427 38501085
    [Google Scholar]
  39. Sack W.H. Multiple forms of stress in refugee and immigrant children. Child and Adolescent. Psychiatric. Clinics of North America. 1998 7 1 153 167 [ix-x. 10.1016/S1056‑4993(18)30265‑7 9894085
    [Google Scholar]
  40. Saha S. Chant D. Welham J. McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Medicine 2005 2 5 e141 10.1371/journal.pmed.0020141 15916472
    [Google Scholar]
  41. Salazar de Pablo G. Catalan A. Vaquerizo Serrano J. Pedruzo B. Alameda L. Sandroni V. Armendariz A. Rodriguez V. Arango C. Moreno C. Downs J. Abbott C. Shin J.I. Solmi M. Fusar-Poli P. Correll C.U. Negative symptoms in children and adolescents with early-onset psychosis and at clinical high-risk for psychosis: Systematic review and meta-analysis. The British Journal of Psychiatry 2023 223 1 282 294 10.1192/bjp.2022.203 37194556
    [Google Scholar]
  42. Salazar de Pablo G. Radua J. Pereira J. Bonoldi I. Arienti V. Besana F. Soardo L. Cabras A. Fortea L. Catalan A. Vaquerizo-Serrano J. Coronelli F. Kaur S. Da Silva J. Shin J.I. Solmi M. Brondino N. Politi P. McGuire P. Fusar-Poli P. Probability of transition to psychosis in individuals at clinical high risk. JAMA Psychiatry 2021 78 9 970 978 10.1001/jamapsychiatry.2021.0830 34259821
    [Google Scholar]
  43. Scharpf F. Kaltenbach E. Nickerson A. Hecker T. A systematic review of socio-ecological factors contributing to risk and protection of the mental health of refugee children and adolescents. Clinical. Psychology. Review 2021 83 101930 10.1016/j.cpr.2020.101930 33186775
    [Google Scholar]
  44. Schiess-Jokanovic J. Knefel M. Kantor V. Weindl D. Schäfer I. Lueger-Schuster B. Complex post-traumatic stress disorder and post-migration living difficulties in traumatised refugees and asylum seekers: The role of language acquisition and barriers. European Journal of Psychotraumatology, 2021 12 1 2001190 10.1080/20008198.2021.2001190 34900122
    [Google Scholar]
  45. Scott J. Chant D. Andrews G. Martin G. McGrath J. Association between trauma exposure and delusional experiences in a large community-based sample. The British Journal of Psychiatry, 2007 190 4 339 343 10.1192/bjp.bp.106.026708 17401041
    [Google Scholar]
  46. Sierau S. Schneider E. Nesterko Y. Glaesmer H. Alone, but protected? Effects of social support on mental health of unaccompanied refugee minors. European. Child Adolescent Psychiatry 2019 28 6 769 780 10.1007/s00787‑018‑1246‑5 30382357
    [Google Scholar]
  47. Solmi M. Soardo L. Kaur S. Azis M. Cabras A. Censori M. Fausti L. Besana F. Salazar de Pablo G. Fusar-Poli P. Meta-analytic prevalence of comorbid mental disorders in individuals at clinical high risk of psychosis: The case for transdiagnostic assessment. Molecular Psychiatry 2023 28 6 2291 2300 10.1038/s41380‑023‑02029‑8 37296309
    [Google Scholar]
  48. Sturm G. Heidenreich F. Moro M. Transcultural clinical work with immigrants, asylum seekers and refugees at Avicenne Hospital, France. International Journal of Migration Health. and Social Care 2009 4 4 33 40 10.1108/17479894200800022
    [Google Scholar]
  49. Tarricone I. Atti A.R. Braca M. Pompei G. Morri M. Poggi F. Melega S. Stivanello E. Tonti L. Nolet M. Berardi D. Migrants referring to the bologna transcultural psychiatric team: Reasons for drop-out. International Journal of Social Psychiatry 2011 57 6 627 630 10.1177/0020764010382368 20851829
    [Google Scholar]
  50. Vancampfort D. Stubbs B. Mitchell A.J. De Hert M. Wampers M. Ward P.B. Rosenbaum S. Correll C.U. Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: A systematic review and meta‐analysis. World Psychiatry 2015 14 3 339 347 10.1002/wps.20252 26407790
    [Google Scholar]
  51. Weiser M. Werbeloff N. Vishna T. Yoffe R. Lubin G. Shmushkevitch M. Davidson M. Elaboration on immigration and risk for schizophrenia. Psychological Medicine 2008 38 8 1113 1119 10.1017/S003329170700205X 17988415
    [Google Scholar]
  52. Yung A.R. Phillips L.J. Yuen H.P. Francey S.M. McFarlane C.A. Hallgren M. McGorry P.D. Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group. Schizophrenia Research 2003 60 1 21 32 10.1016/S0920‑9964(02)00167‑6 12505135
    [Google Scholar]
  53. Yung A.R. Yung A.R. Pan Yuen H. Mcgorry P.D. Phillips L.J. Kelly D. Dell’olio M. Francey S.M. Cosgrave E.M. Killackey E. Stanford C. Godfrey K. Buckby J. Mapping the onset of psychosis: The Comprehensive assessment of at-risk mental states. Australian and New Zealand Journal of Psychiatry 2005 39 11-12 964 971 10.1080/j.1440‑1614.2005.01714.x 16343296
    [Google Scholar]
/content/journals/aps/10.2174/0122106766389831251028050556
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  • Article Type:     Case Report
Keywords: misdiagnosis ; Clinical high risk ; cross-cultural psychiatry ; migrant youth mental health ; unaccompanied refugee minors ; complex trauma ; psychotic transition

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