Persistence of psychosis spectrum symptoms in the Philadelphia Neurodevelopmental Cohort: a prospective two‐year follow‐up

Abstract

Prospective evaluation of youths with early psychotic-like experiences can enrich our knowledge of clinical, biobehavioral and environmental risk and protective factors associated with the development of psychotic disorders. We aimed to investigate the predictors of persistence or worsening of psychosis spectrum features among US youth through the first large systematic study to evaluate subclinical symptoms in the community. Based on Time 1 screen of 9,498 youth (age 8-21) from the Philadelphia Neurodevelopmental Cohort, a subsample of participants was enrolled based on the presence (N5249) or absence (N5254) of baseline psychosis spectrum symptoms, prior participation in neuroimaging, and current neuroimaging eligibility. They were invited to participate in a Time 2 assessment two years on average following Time 1. Participants were administered the Structured Interview for Prodromal Syndromes, conducted blind to initial screen status, along with the Schizotypal Personality Questionnaire and other clinical measures, computerized neurocognitive testing, and neuroimaging. Clinical and demographic predictors of symptom persistence were examined using logistic regression. At Time 2, psychosis spectrum features persisted or worsened in 51.4% of youths. Symptom persistence was predicted by higher severity of subclinical psychosis, lower global functioning, and prior psychiatric medication at baseline. Youths classified as having psychosis spectrum symptoms at baseline but not at follow-up nonetheless exhibited comparatively higher symptom levels and lower functioning at both baseline and follow-up than typically developing youths. In addition, psychosis spectrum features emerged in a small number of young people who previously had not reported significant symptoms but who had exhibited early clinical warning signs. Together, our findings indicate that varying courses of psychosis spectrum symptoms are evident early in US youth, supporting the importance of investigating psychosis risk as a dynamic developmental process. Neurocognition, brain structure and function, and genomics may be integrated with clinical data to provide early indices of symptom persistence and worsening in youths at risk for psychosis.

The association between psychotic experiences and disability: results from the WHO World Mental Health Surveys

“…For example, birth cohort studies have found that PEs were more common in children with (a) lower intelligence (35), (b) cognitive deficits such as slower processing speed (36), or (c) neurodevelopmental disorders including dyslexia, dyspraxia and related problems (37). Thus, both PEs and disability may be downstream consequences of neurodevelopmental disorders (38), rather than causally related. Regardless of the causal pathways, our findings indicate that those with PEs are more disabled.…”

Improving outcomes of first‐episode psychosis: an overview

“…A complementary approach may be based on the use of sequential testing methods. The sequential use of screening instruments and CHR‐P assessment in non‐help‐seeking adolescents from the general population may identify individuals who are at potential risk of developing psychosis in the following years. Sequential testing is in line with the clinical staging model and can be further enhanced by front‐line primary care youth mental health models developed to facilitate the access of young people from the school and community (see https://www.headspace.org.au).…”

Do childhood psychotic experiences improve the prediction of adolescent psychopathology? A longitudinal population‐based study

“…In the majority of cases, PE are transient phenomena. It has previously been reported that PE, even when transient, is associated with increased risk of subsequent psychopathology (Calkins et al, ). However, there is also evidence that this relationship may be confounded by baseline psychopathology, and after accounting for this, there is no longer a relationship between transient PE and subsequent psychopathology (Downs, Cullen, Barragan, & Laurens, ).…”

“…In the majority of cases, PE are transient phenomena. It has previously been reported that PE, even when transient, is associated with increased risk of subsequent psychopathology (Calkins et al, 2017).…”