Early-onset Psychoses: Comparison of Clinical Features and Adult Outcome in 3 Diagnostic Groups

Abstract

A comparison of clinical features and adult outcome in adolescents with three types of psychotic disorders: schizophrenic (SPh), schizoaffective (SA) and bipolar with psychotic features (BPP). Subjects (n = 41) were finally diagnosed (DSM-IV criteria) with SPh (n = 17), SA (n = 11) or BPP (n = 13). Clinical evaluation took place at onset and at a 3-year follow-up in all 41, and at least after 5 years in 36 patients. Symptoms were rated on the basis of the Positive and Negative Syndrome Scale (PANSS), integrating items from the Brief Psychiatric Rating Scale (BPRS) and the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). The Children Global Assessment Scale (C-GAS) and the Global Assessment Scale (GAF) were used to evaluate global functioning. Significant differences in clinical features were found in the three diagnostic groups as regards several parameters, some present on one and not on other rating scales, underscoring the insufficiency of a single scale for accurate analysis of the features of a psychotic disorder. At onset, a comparison using the simple presence/absence of symptoms showed scant differences among groups, while differences emerged if symptom severity was included in the comparison. Functioning at 3- and 5-year follow-ups showed a significantly better outcome in the BPP group and more substantial deterioration, with similar evolution, in the SPh and SA groups. The integration of several rating scales differentiated between diagnostic groups more effectively. The similar adult functioning outcome in the SPh and SA groups showed how difficult it is to clearly separate these two disorders.

The Association Between Schizophrenia and Rheumatoid Arthritis: A Nationwide Population-Based Swedish Study on Intraindividual and Familial Risks

“…7 Further, we found no associations between BD and RA despite a previous study's report of a shared polygenic component of schizophrenia and BD of 68%. 25 In light of the more severe loss of function in schizophrenia and schizoaffective disorder patients in comparison to BD patients, 26 this is compatible with differential misclassification bias in the observed inverse association between schizophrenia and RA. Interestingly, patients with schizophrenia or related psychosis have been reported to be at increased risk of other autoimmune diseases with a different symptomatology.…”

Assessing Disordered Thoughts in Preschoolers with Dysregulated Mood

“…Thought disorder is a primary symptom in adults with schizophrenia and bipolar disorder. However, bipolar disorder and schizophrenia cannot be differentiated on this symptom alone (40, 41). Furthermore, thought disorder may be prodromal for either bipolar disorder or schizophrenia (42).…”

A systematic review of the long-term outcome of early onset schizophrenia

“…All GFS studies used scales running from 0 to 100. A total of 10 studies used GFS scales [5,23,32,39,40,50-53,55]. The GFS studies were categorized as a “poor” outcome (score ≤ 50), “moderate” outcome (score 51–70), or “good” outcome (score >70).…”

“…Multiple studies noted sex differences without reporting stratified data. Time period of diagnosis considered studies including patients diagnosed before and after 1970 (<1970+) [1,6,18,23,29,32,49] and studies with all patients diagnosed in 1970 and later (≥1970) [5,8,11,15,34,36,38,40,41,52,53,55]. …”