Which Aspects of Long-Term Outcome Are Predicted by Positive and Negative Symptoms in Early-Onset Psychosis? An Exploratory Eight-Year Follow-Up Study

Abstract

Background: Early-onset psychoses show substantial variability of diagnostic and functional outcome. Finding reliable prognostic factors may allow to allocate resources to those with the worst prognosis. The aim of the study was to gain new insights regarding the potential value of baseline negative and positive symptoms as predictors of outcome in psychoses of early onset. Method: Sixty-three patients with early-onset schizophrenia spectrum psychosis hospitalized in an adolescent psychiatry unit were assessed with the Positive and Negative Syndrome Scale during the index admission. Associations with diagnosis, illness course and functional outcome were analysed in mean 8 years of follow-up (range 3.4-13.5 years). Results: The mean age at the index admission and the follow-up was 16.6 ± 1.2 and 24.5 ± 3.0 years, respectively. A significant majority of subjects continued psychiatric treatment (95%) and had been readmitted (71%). The mortality rate was 3% (suicide and accident). Negative symptoms were related to mental health service utilization during the follow-up. General severity of symptoms, specifically positive and cognitive factors were associated with the diagnosis of schizophrenia and inversely with diagnostic shift outside the schizophrenia spectrum at the catamnesis. Poor impulse control at baseline was associated with worse functional outcome. The drug-free subgroup with no occupational/educational activity compared with the drug-treated subjects showed lower levels of baseline negative symptomatology. Conclusion: The study findings suggest that in patients with early-onset psychosis negative and positive symptoms show a differential prognostic value. Pharmacotherapy may attenuate the effect of symptoms on functional outcome. These hypotheses need to be tested in future studies using confirmatory approaches.

Systematic review and meta-analysis of the efficacy and safety of minocycline in schizophrenia

“…[18][19][20] In addition, these pathways may interact to drive neuroprogression in this illness. 12 Negative [21][22][23][24] and cognitive 25,26 symptoms of schizophrenia are the main determinants of the prognosis and course of schizophrenia. 22 The mechanism of action of minocycline in schizophrenia has been reviewed elsewhere.…”

“…12 Negative [21][22][23][24] and cognitive 25,26 symptoms of schizophrenia are the main determinants of the prognosis and course of schizophrenia. 22 The mechanism of action of minocycline in schizophrenia has been reviewed elsewhere. 27 This secondgeneration tetracycline antibiotic has anti-inflammatory properties, inhibits microglial activation, decreases O&NS, inhibits apoptosis, and modulates glutamatemediated excitotoxicity.…”

“…– 20 In addition, these pathways may interact to drive neuroprogression in this illness 12 . Negative 21 – 24 and cognitive 25 , 26 symptoms of schizophrenia are the main determinants of the prognosis and course of schizophrenia 22 …”

Negative symptoms in children and adolescents with early-onset psychosis and at clinical high-risk for psychosis: systematic review and meta-analysis

“…Individual studies did find a greater severity of negative symptoms in the schizophrenia subgroup. 125 This finding suggests that negative symptoms do not only appear in schizophrenia and should be evaluated and monitored in children and adolescents in the early stages of psychosis regardless of their diagnosis or presentation. That said, there may be some individuals in whom the therapeutic intensity of pharmacological interventions, particularly antipsychotic treatment, could be minimised and psychosocial interventions could be offered instead.…”

Long-Term Outcomes and Predictors of Childhood-Onset Schizophrenia: A Naturalistic Study of 6-year Follow-Up in China

“…A 3year follow-up study of EOS (25) in China found that 58.4% of the follow-up sample were hospitalized twice or more. Another study (26) showed that after a mean follow-up of 8 years, 71% of EOS spectrum psychosis patients had been rehospitalized. We found that the COS sample had an average of 1.34 ± 0.67 hospital admissions, and only 25.9% had been readmitted during the follow-up period.…”