Predictors of Functional and Clinical Outcome in Early-Onset First-Episode Psychosis

Abstract

Baseline clinical assessments have a better predictive value than biological assessments for 2-year follow-up functioning of children and adolescents with a first episode of psychosis. Patients with primary negative symptoms at baseline continue to have negative symptoms 2 years later, and neurostructural markers predict these. Clinicians must still rely on clinical variables to judge the functional prognosis of early-onset first psychotic episodes.

Clinical and demographic differences between patients with manic, depressive and schizophrenia‐spectrum psychoses presenting to Early Intervention Services in London

“…These results underscore the multifaceted aetiology of these conditions and demonstrate the degree of overlap between the subgroups. In this study, SZ patients often occupied an intermediate level between DP and MP patients, and previous research has already proposed SA disorder as the intermediate between SZ and MP (Benabarre et al, 2001;Parellada et al, 2015;Tamminga et al, 2013;Tondo et al, 2016). These findings contribute to the ongoing discussion concerning the existence of a psychosis spectrum (Crow, 1990;Van Os et al, 2009).…”

“…Most research to date on the association of psychosocial risk factors with psychosis has focused on SZ psychoses (Ayesa-Arriola et al, 2016;Compton, Kelley, & Ionescu, 2014;Crow, 1990;Jablensky, 2006). There have, in addition, been several studies comparing psychosocial factors in SZ, manic psychoses (MP) and schizoaffective (SA) psychoses in FEP; the results of these studies identify SA psychosis as an intermediate phenotype between SZ and bipolar disorder (BD), including on psychosocial variables such as age, education and marital status (Benabarre et al, 2001;Cannon, Jones, Gilvarry et al, 1997;Cheniaux, Landeira-Fernandez, Telles et al, 2008;Conus, Cotton, Schimmelmann, McGorry, & Lambert, 2007;Murray et al, 2004;Parellada, Castro-Fornieles, Gonzalez-Pinto et al, 2015;Strauss, Vertinski, Vogel, Ringdahl, & Allen, 2016;Tamminga, Ivleva, Keshavan et al, 2013;Tondo, Vázquez, Baethge et al, 2016).…”

Psychotic and affective symptoms of early-onset bipolar disorder: an observational study of patients in first manic episode

“…13,19 Recent studies on dimensional models during the course of the disease have suggested that disorganization may represent an independent dimension (which some authors term the cognitive dimension), 19 which alongside the psychotic dimension (e.g., hallucinations and delusions) and the other two or three dimensions (depressive dimension; negative symptoms dimension; hostility or excitement dimension), make up the symptomatic constellation for the diagnosis of schizophrenia, BD, and other psychotic syndromes. 18,19,31 The similar occurrence of psychotic symptoms during first manic episode in both age groups (early and late adolescents) of our sample may suggest that disorganization or psychotic manifestations were not an age-dependent phenomenon, but rather were related to the severity of the disorder, i.e., a BDspecific phenomenon as suggested by Angst. 11 Most of our patients presented simultaneous manifestations of manic, psychotic, and disorganized symptoms.…”

“…We recommend that clinicians consider BD as an alternative diagnosis parallel to schizophrenia when dealing with children and adolescents in first psychotic episode. 7,14,18 Researchers have called for improved training of practitioners to recognize pathological delusions and hallucinations, as well as different dimensions of a psychotic syndrome in children and adolescents. 7,13…”

“…Therefore, an accurate distinction of the array of psychotic syndromes present in childhood and adolescence remains a key challenge to practitioners, especially during the initial phase of the psychotic illness, when the clinical features are compound and symptoms often overlap. 3,6,8,[16][17][18] Child and adolescent psychiatry practitioners tended to overlook affective manifestations in patients with psychotic symptoms or to poorly investigate psychotic and disorganization symptoms in mood disorders, allowing diagnostic uncertainty between BD and schizophrenia. 9,18 The validity and reliability of diagnosing BD and schizophrenia in children and adolescents remain a source of debate.…”