Functional deterioration from the premorbid period to 2 years after the first episode of psychosis in early-onset psychosis

Abstract

The aim of the study was to analyze changes in functional adjustment from childhood to 2 years after the first episode of psychosis (FEP) in patients with early-onset schizophrenia spectrum disorders (SSD) and affective psychoses (AFP) and a good or intermediate level of premorbid adjustment. We followed 106 adolescents (aged 12-17 years) with FEP for 2 years after recruitment. Premorbid adjustment in childhood was assessed in 98 patients with the childhood subscale of the Cannon-Spoor Premorbid Adjustment Scale (c-PAS). Global functioning was assessed 2 years after the FEP with the Children's Global Assessment Scale (c-GAS) or the Global Assessment of Functioning scale (GAF), as appropriate. Functional deterioration was defined as a downward shift in the level of functional adjustment from childhood to 2 years after the FEP. In patients with good or intermediate premorbid adjustment, functional deterioration was observed in 28.2 % (26.5 % of the AFP group, 29.4 % of the SSD group). Longer duration of untreated psychosis (Beta = 0.01; P = 0.01) and higher symptom severity at the FEP, as measured with the Clinical Global Impression Scale (Beta = 1.12; P = 0.02), significantly predicted the presence of functional deterioration, accounting for 21.4 % of the variance. Irrespective of diagnosis (SSD or AFP), almost one-third of adolescents with FEP and good or intermediate premorbid adjustment showed functional deterioration from the premorbid period to 2 years after the FEP.

Magnitude and associated factors of disability in patients with schizophrenia attending Gondar, Felegehiwot and Debretabor hospitals Amhara North West Ethiopia 2019: Institutional based cross-sectional study.

“…The odds of developing disability were 3.78 times higher among respondents who had 5 and more years of untreated psychosis as compared with those respondents who were not treated for less than two year which is similar with the results of other studies (38,42).The possible explanation might be there is an association between longer duration of untreated psychosis and poor outcome in schizophrenia. These studies have been interpreted as providing evidence that untreated psychosis may constitute an "active morbid process" that is "toxic" to the brain which leads to disability (43).…”

Predictors of functioning in people suffering from first‐episode psychosis 1 year into entering early intervention service in Hong Kong

“…It is worth noting that the variances explained by the regression models were relatively small. In fact, various other trials exploring the predictive effects of psychopathology on functioning 4,5,8,13,20,24 yielded similar ranges of variances from 21.0% to 39.4%. The relatively small explained variance in this study might be due to the fact that cognitive abilities, one of the well-established predictors of functioning, 5,10,12,19,20 were not assessed.…”

“…2,6,[8][9][10][11][12] Being diagnosed with schizophrenia remained a poor prognostic indicator of functioning. 8 Many studies argued that a longer duration of untreated psychosis was indicative of poorer functional outcomes, 7,13,14 yet negative studies existed. 10,15 While more severe positive, negative, depressive and cognitive symptoms were all indicative of poorer functional status, 2,4,5,7,12,13,[16][17][18][19][20] early symptomatic remission and functional recovery at 6-12 months after initiation of treatment appeared to be more predictive of longerterm functional outcomes.…”

“…8 Many studies argued that a longer duration of untreated psychosis was indicative of poorer functional outcomes, 7,13,14 yet negative studies existed. 10,15 While more severe positive, negative, depressive and cognitive symptoms were all indicative of poorer functional status, 2,4,5,7,12,13,[16][17][18][19][20] early symptomatic remission and functional recovery at 6-12 months after initiation of treatment appeared to be more predictive of longerterm functional outcomes. 6,9,[21][22][23][24] The early intervention service in Hong Kong was established in 2001, and was named EASY, that is, Early Assessment Service for Young people with early psychosis.…”

Perinatal complications and executive dysfunction in early-onset schizophrenia

“…About 4% of the schizophrenia population develop psychosis between 12 and 18 years of age, also referred to as early-onset schizophrenia (EOS) [34][35][36]. Compared to later onset, EOS is associated with increased functional and cognitive deficits and more severe developmental and premorbid deviations [35][36][37][38]. Research on EOS samples is needed because OC seem to affect subgroups of schizophrenia patients differently [1].…”