Age at onset and the outcomes of schizophrenia: A systematic review and meta‐analysis

Abstract

The aim of this study was to analyse the effect of age at onset on the long‐term clinical, social and global outcomes of schizophrenia through a systematic review and a meta‐analysis. Original studies were searched from Web of Science, PsycINFO, Pubmed and Scopus, as well as manually. Naturalistic studies with at least a 2‐year follow‐up were included. Of the 3509 search results, 81 articles fulfilled the inclusion criteria. The meta‐analysis was performed in Stata as a random‐effect analysis with correlation coefficients between age at onset and the outcomes (categorized into remission, relapse, hospitalization, positive symptoms, negative symptoms, total symptoms, general clinical outcome, employment, social/occupational functioning and global outcome). There was a statistically significant (P < .05) correlation between younger age at onset and more hospitalizations (number of studies, n = 9; correlation, r = 0.17; 95% confidence interval, CI 0.09–0.25), more negative symptoms (n = 7; r = 0.14; 95% CI 0.01–0.27), more relapses (n = 3; r = 0.11; 95% CI 0.02–0.20), poorer social/occupational functioning (n = 12; r = 0.15; 95% CI 0.05–0.25) and poorer global outcome (n = 13; r = 0.14; 95% CI 0.07–0.22). Other relationships were not significant. This was the first systematic review of the effects of age at onset on the long‐term outcomes of schizophrenia. The results show that age at onset has a small, but significant impact on some of the outcomes of schizophrenia.

Mismatch Negativity Indices as a Prognostic Factor for Remission in Schizophrenia

“…Our results showed that age, age at onset, initial symptom severity, and MMN amplitude at the Fz site could predict schizophrenia remission. The result was consistent with previous studies in which age at onset and baseline PANSS scores predicted remission [32,33]. Besides the clinical variables, biological markers, such as MMN, might predict schizophrenia remission.…”

Negative symptoms of psychosis: A life course approach and implications for prevention and treatment

“…A further interesting avenue of investigation for negative symptom development is the role of protective factors, which may impact on negative symptom reserve. Individuals with short DUP (Boonstra et al, 2012), older age of onset (Immonen, Jaaskelainen, Korpela, & Miettunen, 2017), more years in education (Clarke et al, 2006), female sex (Leung & Chue, 2000) and married marital status (Makinen et al, 2010) have been shown to have better negative symptom outcomes. Several of these factors are stable regardless of interventions delivered, and an evaluation of whether risk or protective factors for negative symptoms are malleable is an important consideration (Harrigan, McGorry, & Krstev, 2003).…”

Early-Onset Schizophrenia With Predominantly Negative Symptoms: A Case Study of a Drug-Naive Female Patient Treated With Cariprazine

“…Clinical symptoms are often classified in three main domains: positive symptoms, such as hallucinations, delusions, suspiciousness/persecution; negative symptoms, such as emotional withdrawal, blunted affect, and passive social withdrawal; and cognitive symptoms, such as impaired perception, learning, thinking, and memorizing. EOS may be accompanied by greater symptom severity, premorbid developmental impairment, 'soft' neurological signs (eg, clumsiness, motor incoordination), and a higher rate of substance abuse (Hsiao and McClellan, 2008;Clemmensen et al, 2012;Immonen et al, 2017). Accordingly, diagnosis of EOS is often difficult and frequently delayed since onset is more commonly insidious than acute, which makes it difficult to differentiate EOS from underlying cognitive deficits, premorbid functional impairment, or other abnormalities (Russell, 1994;Bartlet, 2014).…”

“…Although early intervention is associated with improvement in negative symptoms (Boonstra et al, 2012), this may be challenging since negative symptoms develop slowly and may be difficult to detect or differentiate from other clinical features (Kirkpatrick et al, 2001;Galderisi et al, 2018). Moreover, a more insidious onset predicts poorer outcome and more severe negative symptoms (Kao and Liu, 2010;Immonen et al, 2017;Murru and Carpiniello, 2018). Diagnosis of patients with predominantly negative symptoms (lacking manifest psychotic signs) is often delayed, resulting in a longer duration of untreated psychosis.…”