Age at the time of onset of psychosis: A marker of specific needs rather than a determinant of outcome?

Abstract

Background: While there is suggestion that early onset of psychosis is a determinant of outcome, knowledge regarding correlates of later onset age is more limited. This study explores the characteristics of patients developing psychosis after age 26, towards the end of the usual age range of early intervention programs, in order to identify potential specific needs of such patients.Methods: 256 early psychosis patients aged 18-35 were followed-up prospectively over 36 months. Patients with onset after 26 ("later onset", LO) were compared to the rest of the sample.Results: LO patients (32% of the sample) had shorter DUP, were less likely to be male, had better premorbid functioning and were more likely to have been exposed to trauma. They had greater insight at presentation and less negative symptoms overall. The trajectories for positive and depressive symptoms were similar in both groups. Evolution of functional level was similar in both groups, but while LO patients recovered faster, they were significantly less likely to return to premorbid functional level. Conclusions:Later psychosis onset correlates with better pre-morbid functioning and higher rate of trauma exposure; the latter should therefore be a treatment focus in such patients. LO patients were less likely to return to premorbid functional level, which suggests that current treatment strategies may not be efficient to help patients maintain employment. The possibility of distinct illness mechanisms according to onset age and the more central role for trauma in patients with onset after age 26 needs to be further explored.

The “Reggio Emilia At‐Risk Mental States” program: A diffused, “liquid” model of early intervention in psychosis implemented in an Italian Department of Mental Health

“…In line with findings reported in other Italian comparable studies (Cocchi et al, ; Ruggeri et al, ), compared with UHR− and UHR+, FEP patients assessed in the ReARMS protocol showed significantly higher mean age at entry and a preponderance of males. These results confirm the well‐known earlier onset of psychosis in males, especially in early adulthood (Golay et al, ). Differently, UHR mental states occurred more frequently in adolescence, hence the importance of overcoming the child‐adult service gap and implementing reformed service models that are not strictly aligned to chronology and rigid diagnostic boundaries (Raballo et al, ).…”

The ‘Parma‐Early Psychosis’ programme: Characterization of help‐seekers with first episode psychosis

“…Consistently with findings reported in ‘Programma 2000’ study (Cocchi et al, 2008, 2013; Cocchi, Cavicchini, et al, 2015b), patients with FEP entered the Pr‐EP programme showed a preponderance of males, confirming literature's data about the prevalence of FEP onset in adult males (Golay et al, 2017). Moreover, at baseline our participants were frequently unemployed, unmarried and living with parents in their family of origin, showing a poorer socio‐occupational functioning.…”

Subtyping based on premorbid profile: A strategy to personalize treatment in first‐episode affective psychosis

“…Indeed, only 56% of patients in the group with later onset returned to their premorbid functioning, and only 24% returned to work at discharge. This is in line with previous findings (Golay et al, 2017) showing that bringing patients back to work is challenging despite employment before psychosis onset, suggesting specific strategies are needed to protect competencies patients acquired before the disorder emerges.…”