Background: Early-onset psychoses show substantial variability of diagnostic and functional outcome. Finding reliable prognostic factors may allow to allocate resources to those with the worst prognosis. The aim of the study was to gain new insights regarding the potential value of baseline negative and positive symptoms as predictors of outcome in psychoses of early onset. Method: Sixty-three patients with early-onset schizophrenia spectrum psychosis hospitalized in an adolescent psychiatry unit were assessed with the Positive and Negative Syndrome Scale during the index admission. Associations with diagnosis, illness course and functional outcome were analysed in mean 8 years of follow-up (range 3.4-13.5 years). Results: The mean age at the index admission and the follow-up was 16.6 ± 1.2 and 24.5 ± 3.0 years, respectively. A significant majority of subjects continued psychiatric treatment (95%) and had been readmitted (71%). The mortality rate was 3% (suicide and accident). Negative symptoms were related to mental health service utilization during the follow-up. General severity of symptoms, specifically positive and cognitive factors were associated with the diagnosis of schizophrenia and inversely with diagnostic shift outside the schizophrenia spectrum at the catamnesis. Poor impulse control at baseline was associated with worse functional outcome. The drug-free subgroup with no occupational/educational activity compared with the drug-treated subjects showed lower levels of baseline negative symptomatology. Conclusion: The study findings suggest that in patients with early-onset psychosis negative and positive symptoms show a differential prognostic value. Pharmacotherapy may attenuate the effect of symptoms on functional outcome. These hypotheses need to be tested in future studies using confirmatory approaches.
Objectives: Early-onset psychoses (EOP) vary considerably with regard to diagnostic stability and functional outcome. The aim of this study was the assessment of executive dysfunction as a predictor of outcome in EOP. Method: This was a retrospective cohort study. Twenty-five hospitalized patients with non-affective EOP were assessed with the Wisconsin Card Sorting Test (WCST) during the index admission. Associations with current diagnosis, further admissions, current treatment status and occupational and relationship outcome were analyzed in 6 years of follow-up. Results: The mean age at the index admission and the follow-up was 16.1 ± 1.35 and 22.0 ± 2.1 years, respectively. After discharge, almost all subjects (96%) at least briefly continued psychiatric treatment, and the majority of them (76%) were readmitted. Worse baseline WCST results were associated with a follow-up schizophrenia diagnosis, being a psychiatric in- or outpatient at the moment of follow-up assessment and receiving psychotropic medication. A low number of completed categories correlated with receiving a disability pension at the follow-up. Conclusion: In patients with EOP, baseline executive function impairment was associated with schizophrenia diagnosis and psychiatric treatment at the follow-up. The association between baseline results and psychiatric treatment may explain the limited effect of baseline impairment on follow-up occupational and relationship status.
Objective:The problem of cognitive dysfunction in eating disorders remains controversial and the research results are not univocal. Because of that, research was undertaken on a homogenous group of young patients suffering from eating disorders, hospitalized in the adolescent unit.Method:The cognitive functions were assessed by Wisconsin Card Sorting Test (WCST) and Digit Span Test in the group of 60 adolescent girls (30 anorectic, 30 bulimic) of the same age and compared with the control group of 39 healthy adolescent girls. Also the relation of cognitive disorders with some clinical features of the illness such as the degree of weight loss, BMI at the admission and discharge and the results of EDI test were assessed.Results:Research results did not show statistically significant differences in the performance in the WCST between anorectic and bulimic patients and the control group. However, the group of anorectic patients show the tendency to perform worse in some parameters of WCST (TA, TE, PE, %PE, %CLR) than the control group, althought the results do not reach statistical significance. The results of the bulimic patients were better (p=0.04) than the control group in the Digit Span Test.No correlation was found between clinical data and results in WCST in eating disorder groups of patients while the correlation was found between results of Digit Span Test and BMI at admission in both clinical groups.Conclusions:The research does not fully confirms that patients suffering from eating disorders show deficits in cognitive functions.
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