Predictors of outcome in early onset schizophrenia: a 10-year follow-up study

Abstract

Background: Younger age at onset is generally thought to be a predictor of poor outcome in Early Onset Schizophrenia (EOS), but there is a paucity of epidemiological data supporting this belief. This study aims to describe long-term outcomes and predictors of patient functioning in EOS, with a focus on the effect of age at onset. Methods: We consecutively enrolled 118 EOS patients who were hospitalized in 2006. Mean age at baseline was 13.3 ± 2.3 years. Sixty-five subjects were successfully interviewed. Mean length of follow up was 10.4 ± 0.3 years. Baseline data were collected from inpatient medical records, while follow up was conducted primarily through telephone interviews of patient relatives. WHODAS 2.0 was used to measure global functioning at follow up. Outcomes included education, employment, marriage status, physical health, subsequent diagnoses and treatment, and patient functioning. Univariate and multivariate regression models were used to assess predictors of outcome, while propensity scores were used to adjust for confounding in analyzing the effect of age at onset on functional outcome. Results: Of the 65 subjects where follow-up data were available, 3 were deceased at follow up. Five (8%) discontinued treatment. Diagnostic stability was 76%. Nearly a quarter (24%) were using clozapine at follow up. In male and female patients, 61 and 55% respectively were overweight, while 29 and 32% respectively were obese. Sixteen (26%) were economically self-sufficient, while 34 (55%) were unemployed. Thirteen (21%) patients had ever been married. The median WHODAS score was 15 (IQR 2 to 35), roughly corresponding to the 78th percentile on population norms. Extroverted personality (p = 0.01), suspicious personality (p = 0.02), and high level of education (p = 0.001) predicted better functioning. Age of onset was not associated with function in either the univariate model (p = 0.24), full model (p = 0.17) or the final risk factor model (p = 0.11), nor after using propensity scores to further adjust for confounders. Conclusion: The long-term functional outcome of EOS is more optimistic than generally believed. Age at disease onset does not predict long-term functional outcome in EOS populations.

Profile of the Young Patient with Schizophrenia Socio-Cultural Characteristics

“…The predominant level of education in the present study is high school (32%), compared to Xu et al's study, where primary school predominates. However, Xu et al register higher percentages for above-average education (27.4% vocational school, 17.7% university education), compared to the present study (16% vocational school, 10% higher education) (4,5).…”

“…In the present study there was a predominance of males (62%) over females (38%). A study carried out in Romania, Bucharest, in 2017 by Octavian Vasiliu et a], revealed a percentage of 53.3% women and 46.7% men, while another study conducted in Chengdu, China in 2020 by Xu et al, revealed percentages of 50% for both women and men (4,5). A comparison of ethnicities carried out in a 2015 study revealed male predominance in all three categories analyzed: white population (80%), black population (68.8%) and Asian (78.1%) (6).…”

“…It is proven that adolescence represents a period of psychobiological crisis in the individual's life. Thus, the consequences of childhood trauma with the existence of some affective disorders on the background of the crisis period in adolescence 1 Hospital of Pneumoftiziology, Galati, Romania 2 "Elisabeta Doamna" Psychiatry Hospital 3 "Dunărea de Jos" University, Faculty of Medicine and Pharmacy 4 Doctoral School of Medicine, University "Ovidius" of Constanta 5 General Hospital "Căi Ferate", Galati, Romania 6 Arestetic Clinic, Galati, Romania 7 University "Dunărea de Jos", Faculty of Kinetotherapy 8 Faculy of Medicine, University "Ovidius" of Constanta 9 Medical Assistance Service of the Municipality of Galați can constitute the trigger of psychosis on the background of various adaptation disorders of the adolescent in which the socio-cultural factor has a crucial importance.…”

Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies

“…Although promotion of good mental health, prevention and early intervention can be implemented over the lifespan, the benefits are maximal when young people are targeted at around the time of onset of mental disorders. Unfortunately, the peak ages and ranges at onset for mental disorders are not fully established, with conflicting findings across [27,28] and within studies [29], partly due to methodological limitations, including selection biases in recruitment for clinical studies [30]. General populationlevel studies (birth cohort, cross-sectional or incidence studies) provide the most robust onset age estimates [30].…”

Polish Psychiatric Association diagnostic and therapeutic management guidelines for patients with early-onset schizophrenia

“…W grupie tej ¼ chorych stosowała klozapinę, 26% osiągnęło niezależność ekonomiczną, a 21% pozostawało w którymś momencie swojego życia w związku małżeńskim. W grupie tej wiek wystąpienia objawów nie okazał się predyktorem poziomu późniejszego funkcjonowania [61]. Bardziej ogólne dane, lecz dotyczące dużej grupy pacjentów (n = 1223 chorych z EOS, okres obserwacji średnio 9,5 roku), uzyskane na podstawie duńskiego rejestru przedstawili Vernal i wsp.…”