Negative Symptoms in Early-Onset Psychosis and Their Association With Antipsychotic Treatment Failure

Abstract

The prevalence of negative symptoms (NS) at first episode of early-onset psychosis (EOP), and their effect on psychosis prognosis is unclear. In a sample of 638 children with EOP (aged 10-17 y, 51% male), we assessed (1) the prevalence of NS at first presentation to mental health services and (2) whether NS predicted eventual development of multiple treatment failure (MTF) prior to the age of 18 (defined by initiation of a third trial of novel antipsychotic due to prior insufficient response, intolerable adverse-effects or non-adherence). Data were extracted from the electronic health records held by child inpatient and community-based services in South London, United Kingdom. Natural Language Processing tools were used to measure the presence of Marder Factor NS and antipsychotic use. The association between presenting with ≥2 NS and the development of MTF over a 5-year period was modeled using Cox regression. Out of the 638 children, 37.5% showed ≥2 NS at first presentation, and 124 (19.3%) developed MTF prior to the age of 18. The presence of NS at first episode was significantly associated with MTF (adjusted hazard ratio 1.62, 95% CI 1.07-2.46; P = .02) after controlling for a number of potential confounders including psychosis diagnostic classification, positive symptoms, comorbid depression, and family history of psychosis. Other factors associated with MTF included comorbid autism spectrum disorder, older age at first presentation, Black ethnicity, and family history of psychosis. In EOP, NS at first episode are prevalent and may help identify a subset of children at higher risk of responding poorly to antipsychotics.

Predictive Factors of Treatment Resistance in First Episode of Psychosis: A Systematic Review

“…Yoshimura et al (76) confirmed the previous results about the influence of negative symptoms on resistance in 131 patients with schizophrenia. Investigation conducted by Downs et al (77) in 638 subjects with early-onset psychosis highlighted the importance of the negative symptomatology in predicting response also in particular populations such as children and adolescents. In fact, authors concluded that early psychosis is characterized by negative symptoms that significantly contributed to the unsuccessful response or resistance to treatment.…”

Admixture analysis of age at onset in older patients with schizophrenia spectrum disorders

“…This explains different cut-offs for EOS and LOS in earlier admixture analyses in younger patient groups, with mean ages ranging from 24.1 to 38.7 years (Liu et al, 2013;Panariello et al, 2010;Schürhoff et al, 2004). There is evidence that an onset of psychosis before 18 years in particular is associated with more severe psychopathology (Kao and Liu, 2010) and poor treatment prognosis (Downs et al, 2019). In addition, in twins, a significantly higher risk of schizophrenia in the second twin was observed when the first twin had an onset of schizophrenia under the age of 22 (Hilker et al, 2017).…”

Risk Assessment Tools and Data-Driven Approaches for Predicting and Preventing Suicidal Behavior

“…Information extraction is an established subfield within NLP seeking to automatically derive structured information from text. In the mental health domain, NLP has been used to extract and classify clinical constructs such as symptoms, clinical treatments and behavioral risk factors (34–41). Using NLP approaches to identify patients at risk of suicidal behavior in addition to, or in combination with, structured data can increase both precision and coverage (26, 42–45).…”