Adolescent vs. adult onset of a first episode psychosis: Impact on remission of positive and negative symptoms

Veru, Franz; Jordan, Gerald; Joober, Ridha; Malla, Ashok; Iyer, Srividya N.

doi:10.1016/j.schres.2016.03.035

Cited by 27 publications

(23 citation statements)

References 38 publications

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“…However, within a shorter time frame (mean length of time between assessments: ~3 months), our results suggest that change in symptom severity is similar across development. Others have found that earlier age of onset is associated with increased time to symptom remission in first-episode samples (Malla et al, 2006;Veru et al, 2016). Unlike our study, these studies did not quantitatively assess change in symptom presentation (regardless of direction).…”

Section: No Evidence Of Developmental Effects Of Change In Positive Acontrasting

confidence: 66%

Developmental Influences on Symptom Expression in Antipsychotic-Naïve First-Episode Psychosis

Bridgwater

Bachman

Tervo‐Clemmens

et al. 2020

Preprint

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Introduction: The neurodevelopmental model of psychosis was established over 30 years ago; however, the developmental influence on psychotic symptom expression -how a person's age affects clinical presentation in first-episode psychosis -has not been thoroughly investigated. Method:Using generalized additive modeling, which allows for linear and non-linear functional forms of age-related change, we leveraged symptom data from a large sample of antipsychoticnaïve individuals experiencing a first episode of psychosis (N=340, 12-40 years, 1-12 visits), collected at the University of Pittsburgh from 1990-2017. We examined relationships between age and severity of perceptual and non-perceptual positive symptoms and negative symptoms. We also tested for age-associated effects on change in positive or negative symptom severity following baseline assessment, and explored the time-varying relationship between perceptual and non-perceptual positive symptoms across adolescent development. Results:In the cross-sectional and longitudinal data, perceptual positive symptoms significantly decreased with increasing age (F=7.0, p=0.0007; q=0.003) while non-perceptual positive symptoms increased with increasing age (F=4.1, p=0.01, q=0.02). These relationships remained significant when SES, IQ, and illness duration were included as covariates. There were no developmental effects on change in positive or negative symptom severity (all p>0.25). Finally, an association between severity of non-perceptual and perceptual symptoms developed with increasing age, with a significant association starting at age 18. Conclusion:These findings suggest that as cognitive maturation proceeds, perceptual symptoms attenuate while non-perceptual symptoms are enhanced, reflecting influences of developmental processes on psychosis expression. Findings underscore how pathological brain-behavior relationships vary as a function of development.

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Section: No Evidence Of Developmental Effects Of Change In Positive Acontrasting

confidence: 66%

Developmental Influences on Symptom Expression in Antipsychotic-Naïve First-Episode Psychosis

Bridgwater

Bachman

Tervo‐Clemmens

et al. 2020

Preprint

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“…Trained research staff administered the Circumstance of Onset and Relapse Schedule , a semi‐structured interview supported by collateral information from family and educational/health records to estimate the DUP of each patient. While there is no gold standard for operationalizing the measurement of DUP, we defined it as the time between the onset of the patient's first threshold level of psychotic symptoms and adequate treatment with antipsychotic medication (30 days of consistent medication, unless remission of positive symptoms was achieved earlier), consistent with previous studies . It has been proposed that the introduction of antipsychotic therapy in adequate dose and for a reasonable duration should be included in measuring DUP .…”

Section: Methodsmentioning

confidence: 96%

Short duration of untreated psychosis enhances negative symptom remission in extended early intervention service for psychosis

Dama

Shah

Norman

et al. 2019

Acta Psychiatr Scand

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A, Malla A. Short duration of untreated psychosis enhances negative symptom remission in extended early intervention service for psychosis Objective: To test whether duration of untreated psychosis (DUP) < 3 months, recommended by the World Health Organization/ International Early Psychosis Association, enhances the effects of an extended early intervention service (EEIS) on symptom remission. Method: We examined data from a randomized controlled trial in which patients who received 2 years of treatment in EIS for psychosis were subsequently randomized to either 3 years of EEIS or 3 years of regular care (RC). Using a DUP cut-off ≤ 12 weeks (approximately < 3 months), patients were split into two groups. Length of positive, negative and total symptom remission were the outcomes. Results: Patients (N = 217) were mostly male (68%) with schizophrenia spectrum disorder (65%); 108 (50%) received EEIS (58 had DUP ≤12 weeks; 50 had DUP >12 weeks). Interaction between treatment condition (EEIS vs. RC) and DUP cut-off ≤ 12 weeks was only significant in multiple linear regression model examining length of negative symptom remission as the outcome (adjusted b = 36.88 [SE = 15.88], t = 2.32, P = 0.02). EEIS patients with DUP ≤12 weeks achieved 25 more weeks of negative symptom remission than EEIS patients with DUP >12 weeks. Conclusion: Having a short DUP may be critical in deriving long-term benefits from EIS for psychosis, including EEIS settings. This work empirically supports policy recommendations of reducing DUP <3 months. Significant outcomes• Having a short DUP of 12 weeks or less may increase the length of negative symptom remission by 25 more weeks among patients receiving treatment in an extended early intervention service for psychosis • These results are independent of known confounds including the age at onset of psychosis, premorbid functioning, having a diagnosis of schizophrenia spectrum disorder and the severity of negative symptoms at the time of randomization • This work provides important empirical support for the World Health Organization and International Early Psychosis Association's recommendation of having a DUP of less than 3 months in early intervention services for psychosis Limitations • Certain patient characteristics not included in this study (e.g. degree of insight and migration status) may have the potential to influence our findings.

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“…Concerning correlates of achieving recovery as an outcome, several studies note the importance of negative symptoms, which were repeatedly associated with being less likely to achieve objective recovery [73][74][75]. Shorter duration of untreated psychosis was also associated with achieving recovery as an outcome for individuals with FEP [75,76]. Conflicting findings exist for the role of cognitive functioning, as Hofer et al [77] found that in 140 individuals diagnosed with schizophrenia, superior frontal lobe functioning was associated with experiencing symptom remission, while Brissos et al [78] found no correlation between cognitive functioning and symptom remission in 76 individuals diagnosed with schizophrenia.…”

Section: Summarized Inmentioning

confidence: 99%

Recovery and serious mental illness: a review of current clinical and research paradigms and future directions

Leonhardt

Huling

Hamm

et al. 2017

Expert Review of Neurotherapeutics

159

123

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Recovery from serious mental illness has historically not been considered a likely or even possible outcome. However, a range of evidence suggests the courses of SMI are heterogeneous with recovery being the most likely outcome. One barrier to studying recovery in SMI is that recovery has been operationalized in divergent and seemingly incompatible ways: as an objective outcome versus a subjective process. Areas covered: This paper offers a review of recovery as a subjective process and recovery as an objective outcome; contrasts methodologies utilized by each approach to assess recovery; reports rates and correlates of recovery; and explores the relationship between objective and subjective forms of recovery. Expert commentary: There are two commonalities of approaching recovery as a subjective process and an objective outcome: (i) the need to make meaning out of one's experiences to engage in either type of recovery and (ii) there exist many threats to engaging in meaning making that may impact the likelihood of moving toward recovery. We offer four clinical implications that stem from these two commonalities within a divided approach to the concept of recovery from SMI.

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Adolescent vs. adult onset of a first episode psychosis: Impact on remission of positive and negative symptoms

Cited by 27 publications

References 38 publications

Developmental Influences on Symptom Expression in Antipsychotic-Naïve First-Episode Psychosis

Developmental Influences on Symptom Expression in Antipsychotic-Naïve First-Episode Psychosis

Short duration of untreated psychosis enhances negative symptom remission in extended early intervention service for psychosis

Recovery and serious mental illness: a review of current clinical and research paradigms and future directions

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