Frequency and pattern of childhood symptom onset reported by first episode schizophrenia and clinical high risk youth

Abstract

Background Psychosis prevention and early intervention efforts in schizophrenia have focused increasingly on sub-threshold psychotic symptoms in adolescents and young adults. Although many youth report symptom onset prior to adolescence, the childhood incidence of prodromal-level symptoms in those with schizophrenia or related psychoses is largely unknown. Methods This study reports on the retrospective recall of prodromal-level symptoms from 40 participants in a first-episode of schizophrenia (FES) and 40 participants at “clinical high risk” (CHR) for psychosis. Onset of positive and non-specific symptoms was captured using the Structured Interview for Prodromal Syndromes. Frequencies are reported according to onset during childhood (prior to age 13), adolescence (13–17), or adulthood (18 +). Results Childhood-onset of attenuated psychotic symptoms was not rare. At least 11% of FES and 23% of CHR reported specific recall of childhood-onset of unusual or delusional ideas, suspiciousness, or perceptual abnormalities. Most recalled experiencing non-specific symptoms prior to positive symptoms. CHR and FES did not differ significantly in the timing of positive and non-specific symptom onset. Other than being younger at assessment, those with childhood onset did not differ demographically from those with later onset. Conclusion Childhood-onset of initial psychotic-like symptoms may be more common than previous research has suggested. Improved characterization of these symptoms and a focus on their predictive value for subsequent schizophrenia and other major psychoses are needed to facilitate screening of children presenting with attenuated psychotic symptoms. Accurate detection of prodromal symptoms in children might facilitate even earlier intervention and the potential to alter pre-illness trajectories.

Early auditory processing evoked potentials (N100) show a continuum of blunting from clinical high risk to psychosis in a pediatric sample

“…Another limitation relates to the assessment of CHR in pediatric populations. Although childhood onset of prodromal symptoms is not rare (Woodberry et al, 2014), identification of CHR in pediatric populations is less reliable than in adults (Schultze-Lutter et al, 2015). Furthermore, the predictive validity of the SIPS, particularly in children under age 10 years, is not established.…”

North American Prodrome Longitudinal Study (NAPLS 2)

“…A retrospective study in patients with a first-episode of psychosis reported that attenuated psychotic symptoms occurred on average 3.9 years before admission to a hospital for a psychotic episode (Schultze-Lutter et al, 2010). A recent prospective study (Woodberry et al, 2014) reported that in a sample of 39 people at CHR for psychosis, for 23% the onset of SOPS unusual thought content, suspiciousness or perceptual abnormalities occurred in childhood, for 38.5% in adolescence, and for 38.5% in adulthood.…”

Progress and Future Directions in Research on the Psychosis Prodrome

“…9, 11 Often earliest to emerge are heterogeneous symptoms: attention problems, depression, anxiety, avolition, social difficulties, disorganization, and sleep disturbances, so-called “non-specific symptoms”. 9, 10, 12, 13 More specific psychotic-like symptoms may emerge closer to the onset of acute psychosis.…”

“…21, 22 They have high rates of cognitive complaints (e.g., concentration or memory problems) and negative symptoms (e.g., low motivation or social anhedonia). 11, 23 Longstanding or worsening functional difficulties are also common. 24, 25 The vast majority has had previous treatment with psychotherapy or psychotropic medications.…”

“…Although psychotic-like symptoms may first present in childhood, assessment of PR in children remains challenging. 11, 18, 37-39 Putatively prodromal symptoms are more common and less predictive of later psychosis. 38, 39 PR is typically assessed in adolescence to early adulthood.…”