Outcome of Youth with Early-Phase Schizophrenia-Spectrum Disorders and Psychosis Not Otherwise Specified Treated with Second-Generation Antipsychotics: 12 Week Results from a Prospective, Naturalistic Cohort Study

Abstract

Objectives: The purpose of this study was to assess differences in the outcomes of youth with schizophrenia-spectrum disorders (SCZ-S) and psychotic disorder not otherwise specified (PsyNOS) during early antipsychotic treatment. Methods: The study was a prospective, naturalistic, inception cohort study of youth £ 19 years old with SCZ-S (schizophrenia, schizoaffective disorder, schizophreniform disorder) or PsyNOS (PsyNOS, brief psychotic disorder) and £ 24 months of lifetime antipsychotic treatment receiving clinician's choice antipsychotic treatment. Baseline demographic, illness and treatment variables, and effectiveness outcomes were compared at 12 weeks last-observation-carried-forward across SCZ-S and PsyNOS patients, adjusting for significantly different baseline variables. Results: Altogether, 130 youth with SCZ-S (n = 42) or PsyNOS (n = 88), mostly antipsychotic naïve (76.9%), were prescribed risperidone (47.7%), olanzapine (19.2%), aripiprazole (14.6%), quetiapine (11.5%), or ziprasidone (6.9%). Compared with those with PsyNOS, SCZ-S youth were older (16.4 -2.1 vs. 14.8 -3.2, p = 0.0040), and less likely to be Caucasian (19.1% vs. 42.5%, p = 0.009). At baseline, SCZ-S patients had significantly higher Clinical Global Impressions-Severity (CGI-S) scores (6.0 -0.9 vs. 5.5 -0.8, p = 0.0018) and lower Children's Global Assessment Scale (CGAS) scores (29.6 -9.2 vs. 36.1 -8.9, p = 0.0002) and were more likely to be in the severely ill CGAS group (i.e., CGAS £ 40). SCZ-S and PsyNOS patients did not differ regarding all-cause discontinuation (40.5 vs. 40.3%. p = 0.49), discontinuation because of adverse effects (12.2% vs. 12.4%, p = 0.97), or nonadherence (29.3% vs. 30.9%, p = 0.88), but somewhat more SCZ-S patients discontinued treatment for inefficacy (19.5% vs. 7.4%, p = 0.063). CGI-S and CGAS scores improved significantly in both diagnostic groups ( p = 0.0001, each). Adjusting for baseline differences, PsyNOS patients experienced significantly better CGI-I improvement (CGI-I) scores ( p = 0.012) and more frequently reached higher categorical CGAS group status ( p = 0.021) than SCZ-S patients. Conclusions: Both youth with SCZ-S and those with PsyNOS experienced significant improvements with clinician's choice antipsychotic treatment. However, treatment discontinuation was common within 12 weeks, with greater inefficacy-related discontinuation in the SCZ-S group, whereas CGI-I and CGAS score-based improvements were greater in the PsyNOS group.

Psychiatric hospitalization following psychosis onset: A retrospective cohort study using health administrative data

“…We observed higher admission rates in the group with an index diagnosis of psychosis NOS compared to schizophrenia spectrum disorders, contrasting with previous evidence (Vernal et al, ). Psychosis NOS has low diagnostic stability, and approximately one‐third of people diagnosed with psychosis NOS are eventually diagnosed with schizophrenia (Fusar‐Poli et al, ).…”

“…We observed higher admission rates in the group with an index diagnosis of psychosis NOS compared to schizophrenia spectrum disorders, contrasting with previous evidence (Vernal et al, 2015).…”

Symptom Profiles in Psychotic Disorder Not Otherwise Specified

“…These studies suggest, however, that patients with PNOS have less severe psychotic symptoms and better short-term outcomes than patients with SZ (16,17). The findings are supported by studies examining PNOS in youths (18)(19)(20). In addition, patients with PNOS appear to have fewer psychotic episodes, shorter durations of illness and better functioning than participants with SZ, according to a larger study comparing all 12 DSM-IV psychotic disorders (3).…”

Limitations of Research on Psychosis in Childhood and Adolescence:Current Controversies and Future Directions

“…In a recent study of the use of atypical antipsychotic medications with child and adolescent psychiatric patients being treated in Spain, Baeza et al [31] reported that Risperidone was the most widely prescribed medication not only for youth with Schizophrenia Spectrum Disorders and Psychosis, Not Otherwise Specified, but also for Disruptive Behavior Disorders. In a very recent study of the 12 week results of the treatment of adolescents with Schizophrenia Spectrum Disorder and Psychosis Not Otherwise Specified, Vernal et al [32] compared Resperidone, Olanzapine, Aripiprazole, Quetiapine, and Ziprasidone. They reported that there were significant improvements with the clinician's choice of medication among both groups of patients, but there were also high rates of discontinuance among both groups.…”