A Prognostic Study of Clinical Dimensions in Adolescent-Onset Psychoses

Abstract

Adolescent-onset psychoses often raise diagnostic difficulties because of the mixture of schizophrenic and affective features. This study examined prospectively which clinical dimensions contribute to difficulty in initial diagnosis and which clinical features have predictive value for outcomes of schizophrenia or affective disorders, and for eventual psychosocial functioning. Thirty-six adolescents consecutively admitted for a psychotic episode were followed up for 1 to 4 years. Symptoms were assessed at admission, at discharge, and once a year. DSM-III-R (APA 1989) diagnoses were assessed at admission and once a year. Comparisons were performed across initial and followup diagnostic groups. Positive symptoms did not differentiate the initial clinical pictures, while negative symptoms, manic symptoms, and disorganization differentiated the manic and depressive episodes in the acute phase. When initial positive symptoms (mainly delusions) were severe, they predicted a final diagnosis in the schizophrenia spectrum. Poor outcome was associated with more anhedonia-associality and lower functioning scores at admission. Results suggest (1) a higher vulnerability to positive symptoms in adolescents who will further develop schizophrenia and (2) the low specificity of affective symptoms at this age.

Social anhedonia and affiliation: Examining behavior and subjective reactions within a social interaction

“…Additionally, the social anhedonia group differed from their normal hedonic counterparts in their self-reported social functioning, consistent with previous research reporting that social functioning deficits are present in non-clinical individuals elevated on social anhedonia (Kwapil, 1998; Diaz et al, 2002; Blanchard et al, 2011). These findings are important because poor social adjustment prior to the onset of schizophrenia is a robust predictor of more adverse long-term outcomes (Hafner et al, 1999; Paillere-Martinot et al, 2000). …”

Predictors of outcome in early-onset psychosis: a systematic review

“…In four studies, the upper limit of the range of the age at onset was >18, but mean age at onset or at baseline was <18 and the authors referred to these as participants with EOP. 20–23 In two studies, the range of the age at onset or at baseline was not provided, but mean age at baseline was <18 and the authors referred to the sample as adolescent onset. 24 , 25 Studies assessed clinical, functional, cognitive, and/or biological (that is, neuroimaging, biochemical) outcome measures or suicide risk.…”

Clinical Profiles, Scope and General Findings of the Western Sydney First Episode Psychosis Project

“…Psychosis is a clinical problem that although rare in the community is a cause of considerable long-term morbidity and mortality [1], [2]. The management of first episode psychosis has altered over the past decade with the development of early intervention teams with their brief of rapid response, engagement, continuity of care and a balanced biopsychosocial approach.…”

“…The management of first episode psychosis has altered over the past decade with the development of early intervention teams with their brief of rapid response, engagement, continuity of care and a balanced biopsychosocial approach. Research has emphasized that caution is needed in determining diagnosis early in the course of illness with the recognition that the boundaries between syndromes are often tenuously based upon duration of symptoms arbitrarily determined [3], or upon a predominant pattern of psychopathology when the admixture of symptoms is increasingly being recognized as the rule [2], [4]. The problems of comorbidity with substance abuse [3], [4] and cognitive impairment [5], [6] are recognized as essential issues to be addressed in the management plan.…”