Which came first, delusions or hallucinations? An exploration of clinical differences among patients with first-episode psychosis based on patterns of emergence of positive symptoms

Abstract

Remarkably little is known about patterns of emergence of specific symptoms in the early course of nonaffective psychotic disorders. Some 159 well-characterized first-episode psychosis patients were categorized into those with: (1) delusions only (n=29, 18.2%); (2) delusions that emerged at least one month before hallucinations (n=31, 19.5%); (3) hallucinations that began at least one month before delusions (n=26, 16.4%); and (4) delusions and hallucinations that emerged concomitantly, within the same month (n=73, 45.9%). These four groups were compared across a number of clinical features, including duration of untreated psychosis, symptom severity, insight, and functioning, while controlling for potential confounders. Patients with delusions and hallucinations emerging within the same month had a shorter duration of untreated psychosis than those in whom one psychotic symptom emerged greater than one month before the other. The delusions-only group had significantly less severe positive, negative, and general psychopathology symptom scores, as well as better social and occupational functioning. Replication and further elucidation of specific patterns of symptom emergence would deepen the field’s understanding of early-course phenomenology, and may inform efforts to improve upon nosology, prognostication, and treatment selection.

Isolated hallucination is less predictive than thought disorder in psychosis: Insight from a longitudinal study in a clinical population at high risk for psychosis

“…There is a dearth of reports on the patterns of emergence of PAs and TCDs symptoms, and it remains unclear which of the two, PAs or TCDs, occur first 15 . Our results suggested that the pattern of emergence of PAs and TCDs may be associated with varying levels of risk for psychosis.…”

Marijuana use in the immediate 5-year premorbid period is associated with increased risk of onset of schizophrenia and related psychotic disorders

“…We also conducted a similar in-depth interview with one or two family members/informants when available. Then, we derived consensus-based best estimates of age at onset of the prodrome and age at onset of psychosis in a standardized fashion, using all available information, as described in prior reports (Compton et al, 2008, Compton et al, 2009a, Compton et al, 2009c, Compton et al, 2011, Compton et al, 2012, Broussard et al, 2013). Dates, including a minimum of month and year, of age at onset of these symptoms were recorded, allowing these variables to be coded in months rather than years.…”

Delusions in first-episode psychosis: Principal component analysis of twelve types of delusions and demographic and clinical correlates of resulting domains

“…Despite the growing interest in first-episode psychosis, a paucity of research on delusions is noticeable in this area of study (Compton et al, 2012; Rajapakse et al, 2011). It is remarkable how, at the present time, although delusions represent one of the core symptoms of schizophrenia and related psychotic disorders, it remains unclear as to whether or not these phenomena should be considered unitary or diversified (Sass and Byrom, 2015), and few studies have investigated distinct delusional themes, in particular in first-episode psychosis samples.…”