Predictors of outcome in early-onset psychosis: a systematic review

Abstract

Given the global burden of psychotic disorders, the identification of patients with early-onset psychosis (EOP; that is, onset before the age of 18) at higher risk of adverse outcome should be a priority. A systematic search of Pubmed, Embase, and PsycInfo (1980 through August 2014) was performed to identify longitudinal observational studies assessing correlates and/or predictors of clinical, functional, cognitive, and biological outcomes in EOP. Seventy-five studies were included in the review. Using multivariate models, the most replicated predictors of worse clinical, functional, cognitive, and biological outcomes in EOP were premorbid difficulties and symptom severity (especially of negative symptoms) at baseline. Longer duration of untreated psychosis (DUP) predicted worse clinical, functional, and cognitive outcomes. Higher risk of attempting suicide was predicted by greater severity of psychotic illness and of depressive symptoms at the first episode of psychosis. Age at onset and sex were not found to be relevant predictors of outcome in most multivariate models, whereas studies using bivariate analyses yielded inconsistent results. Lower intelligence quotient at baseline predicted lower insight at follow-up, worse functional outcomes, and a diagnostic outcome of schizophrenia. Biological predictors of outcome in EOP have been little studied and have not been replicated. Lower levels of antioxidants at baseline predicted greater brain volume changes and worse cognitive functioning at follow-up, whereas neuroimaging markers such as regional cortical thickness and gray matter volume at baseline predicted remission and better insight at follow-up, respectively. EOP patients with poorer premorbid adjustment and prominent negative symptoms at initial presentation are at risk of poor outcome. They should therefore be the target of careful monitoring and more intensive interventions to address whether the disease course can be modified in this especially severely affected group. Early intervention strategies to reduce DUP may also improve outcome in EOP.

The relationship between negative symptoms and cognitive functioning in patients at clinical high risk for psychosis

“…Negative symptoms are already present in ARMS patients and patients with a first-episode psychosis (FEP) and several studies highlighted their importance regarding the outcome of these patient groups. More severe negative symptoms are related to poorer social and role functioning in ARMS (Carrión et al, 2016;Cotter et al, 2014) and FEP patients (Diaz-Caneja et al, 2015), and negative symptoms represent significant predictors for conversion to psychosis Piskulic et al, 2012;Riecher-Rössler et al, 2009;Valmaggia et al, 2013).…”

Cortical Morphology Differences in Subjects at Increased Vulnerability for Developing a Psychotic Disorder: A Comparison between Subjects with Ultra-High Risk and 22q11.2 Deletion Syndrome

“…Importantly, the groups were matched on negative symptom severity. Current literature shows that negative, rather than positive symptom severity, predict transition to psychosis [50,51]. Thus, our results are not biased by a possibly more frequent transition to psychosis in either group.…”

Early and very early‐onset schizophrenia compared with adult‐onset schizophrenia: French FACE‐SZ database

“…In 2011, the NIMH National Institute of Mental Health reference team (Gochman et al, ) announced a VEOS prevalence of approximately 1 in 40,000. The literature gives moreover some comparisons between AOS and EOS and indicates EOS to have: higher suicidality and more depressive symptoms (Joa et al, ), poorer outcomes (Diaz‐Caneja et al, ), and longer duration of untreated psychosis (DUP; Joa et al, ; Schimmelmann et al, ). The DUP is commonly defined as the time interval between onset of positive psychotic symptoms and first adequate treatment (McGlashan, ), but DUP according to age at onset in schizophrenia, has rarely been studied (see Table ), in particular with VEOS.…”