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Giannitelli M, Levinson DF, Cohen D, Xavier J, Laurent-Levinson C. Developmental and symptom profiles in early-onset psychosis. Schizophr Res 2020; 216:470-478. [PMID: 31874744 DOI: 10.1016/j.schres.2019.10.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 08/23/2019] [Accepted: 10/12/2019] [Indexed: 01/01/2023]
Abstract
Psychotic disorders in children are more heterogeneous than is captured by categorical diagnoses. In a new cohort of children and adolescents, we evaluated the relationships among age at onset (AAO), clinical symptoms and developmental impairments. Patients with schizophrenia and other "spectrum" psychotic diagnoses (N = 88; AAO 6-17, mean 12.6) were evaluated with diagnostic interviews, a new clinical scale (Lifetime Dimensions of Psychosis Scale-Child and Adolescent), and neuropsychological and medical evaluations. Key findings were replicated in an adult cohort of 2420 cases, including 127 with retrospective AAO<13. Factor and cluster analyses were carried out to identify clinical profiles. Five clinical factors were identified in each cohort: Positive, Bizarre Positive, Negative/Formal Thought Disorder, Depression and Mania. Earlier AAO predicted severity of bizarre positive symptoms in children and of bizarre and other symptoms in adults. Four clinical clusters in the child cohort were characterized by: more severe bizarre positive symptoms (N = 31); negative symptoms (N = 15); premorbid autism spectrum features and developmental delay (N = 12); and depressive symptoms with heterogeneous diagnoses and mild positive/negative symptoms (N = 25). Previous factor-analytic studies of childhood psychosis did not specifically consider bizarre positive symptoms. Here, bizarre positive symptoms emerged as clinical markers of severe, childhood-onset psychosis similar to adult schizophrenia. The four clusters are clinically meaningful and useful for treatment planning and potentially for biological research. Childhood-onset cases are rare and thus difficult to study, but additional, larger cohorts may be useful in dissecting the biological and developmental heterogeneity of psychotic disorders.
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Affiliation(s)
- Marianna Giannitelli
- Faculté de Médecine Sorbonne Université, Groupe de Recherche Clinique n°15 - Troubles Psychiatriques et Développement (PSYDEV), 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France; Centre de Référence des Maladies Rares à Expression Psychiatrique, Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Universitaire de la Pitié-Salpêtrière, 47 - 83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
| | - Douglas F Levinson
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., Stanford, CA, 94305, USA.
| | - David Cohen
- Faculté de Médecine Sorbonne Université, Groupe de Recherche Clinique n°15 - Troubles Psychiatriques et Développement (PSYDEV), 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France; Centre de Référence des Maladies Rares à Expression Psychiatrique, Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Universitaire de la Pitié-Salpêtrière, 47 - 83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France; Institut des Systèmes Intelligents et de Robotique (ISIR), CNRS UMR7222, Sorbonne Université, Campus Pierre et Marie Curie, Faculté des Sciences et Ingénierie, Pyramide, Tour 55, Boîte courrier 173, 4 Place Jussieu, 75252, Paris Cedex 05, France.
| | - Jean Xavier
- Centre Hospitalier Spécialisé Henri Laborit, Poitiers, France; CNRS UMR 7295 Centre de Recherches sur la Cognition et l'Apprentissage, Bâtiment A5, 5, rue Théodore Lefebvre, 86000, Poitiers, France.
| | | | - Claudine Laurent-Levinson
- Faculté de Médecine Sorbonne Université, Groupe de Recherche Clinique n°15 - Troubles Psychiatriques et Développement (PSYDEV), 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France; Centre de Référence des Maladies Rares à Expression Psychiatrique, Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Universitaire de la Pitié-Salpêtrière, 47 - 83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
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Fu-I L, Gurgel WDS, Caetano SC, Machado-Vieira R, Wang YP. Psychotic and affective symptoms of early-onset bipolar disorder: an observational study of patients in first manic episode. ACTA ACUST UNITED AC 2019; 42:168-174. [PMID: 31576937 PMCID: PMC7115441 DOI: 10.1590/1516-4446-2019-0455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/30/2019] [Indexed: 01/21/2023]
Abstract
Objective: Presence of psychotic symptoms seems to be a commonplace in early-onset bipolar disorder (BD). However, few studies have examined their occurrence in adolescent-onset BD. We sought to investigate the frequency of affective and psychotic symptoms observed during the first manic episode in adolescents. Methods: Forty-nine adolescents with bipolar I disorder (DSM-IV criteria) were admitted to a psychiatric hospital during their first acute manic episode. Assessment for current psychiatric diagnosis was performed by direct clinical interview and the DSM-IV version of the Diagnostic Interview for Children and Adolescents (DICA). Results: Teenage inpatients with BD consistently exhibited typical manic features, such as euphoria, grandiosity, and psychomotor agitation. In addition, disorganization and psychotic symptoms were present in 82 and 55% of the total sample, respectively. There was no significant difference in symptoms between early- and late-adolescent subgroups. Remarkably, most patients (76%) reported previous depressive episode(s); of these, 47% had prominent psychotic features in the prior depressive period. Conclusion: These findings suggest that disorganization and psychotic symptoms during the first manic episode are salient features in adolescent-onset BD, and that psychotic depression frequently may precede psychotic mania. Nevertheless, differential diagnosis with schizophrenia should be routinely ruled out in cases of early-onset first psychotic episode.
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Affiliation(s)
- Lee Fu-I
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Wagner de S Gurgel
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Sheila C Caetano
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Yuan P Wang
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Perdahli Fis N, Gumustas F. Early-onset psychosis: What is the diagnostic outcome? EUROPEAN JOURNAL OF PSYCHIATRY 2018. [DOI: 10.1016/j.ejpsy.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Craddock KES, Zhou X, Liu S, Gochman P, Dickinson D, Rapoport JL. Symptom dimensions and subgroups in childhood-onset schizophrenia. Schizophr Res 2018; 197:71-77. [PMID: 29146021 PMCID: PMC5949241 DOI: 10.1016/j.schres.2017.10.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/29/2017] [Accepted: 10/29/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study investigated symptom dimensions and subgroups in the National Institute of Mental Health (NIMH) childhood-onset schizophrenia (COS) cohort and their similarities to adult-onset schizophrenia (AOS) literature. METHOD Scores from the Scales for the Assessment of Positive and Negative Symptoms (SAPS & SANS) from 125 COS patients were assessed for fit with previously established symptom dimensions from AOS literature using confirmatory factor analysis (CFA). K-means cluster analysis of each individual's scores on the best fitting set of dimensions was used to form patient clusters, which were then compared using demographic and clinical data. RESULTS CFA showed the SAPS & SANS data was well suited to a 2-dimension solution, including positive and negative dimensions, out of five well established models. Cluster analysis identified three patient groups characterized by different dimension scores: (1) low scores on both dimensions, (2) high negative, low positive scores, and (3) high scores on both dimensions. These groups had different Full scale IQ, Children's Global Assessment Scale (CGAS) scores, ages of onset, and prevalence of some co-morbid behavior disorders (all p<3.57E-03). CONCLUSION Our analysis found distinct symptom-based subgroups within the NIMH COS cohort using an established AOS symptom structure. These findings confirm the heterogeneity of COS and were generally consistent with AOS literature.
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Affiliation(s)
- Kirsten E S Craddock
- Child Psychiatry Branch, Intramural Research Program, National Institute of Mental Health, NIH, 10 Center Drive, Bldg. 10- Rm. 4N244, Bethesda, MD 20814, United States
| | - Xueping Zhou
- Child Psychiatry Branch, Intramural Research Program, National Institute of Mental Health, NIH, 10 Center Drive, Bldg. 10- Rm. 4N244, Bethesda, MD 20814, United States
| | - Siyuan Liu
- Child Psychiatry Branch, Intramural Research Program, National Institute of Mental Health, NIH, 10 Center Drive, Bldg. 10- Rm. 4N244, Bethesda, MD 20814, United States.
| | - Peter Gochman
- Child Psychiatry Branch, Intramural Research Program, National Institute of Mental Health, NIH, 10 Center Drive, Bldg. 10- Rm. 4N244, Bethesda, MD 20814, United States
| | - Dwight Dickinson
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, NIH, 10 Center Drive, Bldg. 10- Rm. 3C115, Bethesda, MD 20814, United States
| | - Judith L Rapoport
- Child Psychiatry Branch, Intramural Research Program, National Institute of Mental Health, NIH, 10 Center Drive, Bldg. 10- Rm. 4N244, Bethesda, MD 20814, United States
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Early onset first episode psychosis: dimensional structure of symptoms, clinical subtypes and related neurodevelopmental markers. Eur Child Adolesc Psychiatry 2018; 27:171-179. [PMID: 28748485 PMCID: PMC5842250 DOI: 10.1007/s00787-017-1026-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 07/10/2017] [Indexed: 01/01/2023]
Abstract
Despite the growing interest in a dimensional approach to the assessment of symptoms and clinically relevant phenomena in schizophrenia spectrum disorders, very few studies, to date, have examined the dimensional structure of symptoms in early onset first episode psychosis. In the present study, we assessed a sample of 60 children and adolescents of both sexes with first episode schizophrenia spectrum psychosis. A principal component analysis (PCA) of the Positive and Negative Syndrome Scale (PANSS) was performed and the factors obtained were used to carry out a cluster analysis. Sex, age of onset before or after 13, markers of early neurodevelopmental impairment and intellectual disabilities were considered as variables to characterized potential clinical subtypes, applying a one-way analysis of variance. Four factors were extracted ("negative symptoms", "delusions", "conceptual disorganization" and "paranoid/hostility"), each of them identifying a discrete clinical subtype of patients. No difference was found among the groups about sex and age of onset; delayed speech/language development was significantly associated with the "delusions" subtype and both "conceptual disorganization" and "delusions" subtypes showed a lower intelligence quotient (IQ). The four factors model we presented highlights "negative symptoms" as the most consistent factor; among positive symptoms, unusual thought content and conceptual disorganization resulted more distinctive of psychosis, at this age range, than perceptual abnormalities. Evolutionary trajectories of the four clinical subtypes we obtained seem to be influenced by cognitive and neurodevelopmental impairment rather than sex and age of onset.
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Talonen S, Väänänen J, Kaltiala-Heino R. Gender differences in first onset Schizophrenia spectrum psychoses. Nord J Psychiatry 2017; 71:131-138. [PMID: 27774832 DOI: 10.1080/08039488.2016.1245783] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Mental health profiles differ between boys and girls from puberty onwards. It is not known whether differences also extend to symptom presentation in schizophrenia spectrum disorders. It may be that girls and boys are not treated entirely equally by the professionals. AIMS To study gender differences in symptom profiles, family adversities, pathway to care, and characteristics of inpatient treatment at the first episode of diagnosed schizophrenia spectrum disorder (F20-29) among adolescents aged 13-17. METHODS A retrospective chart review of all (n = 106) consecutive adolescents diagnosed for the first time with schizophrenia spectrum disorder (F20-29) in a specified catchment area. Girls and boys were compared with regard to sociodemographics, pathways to care, living arrangements, symptom profiles, and treatment received. RESULTS During the study period more adolescent girls (n = 70, 66%) than boys (n = 36, 34%) were diagnosed with schizophrenia spectrum (F20-29) psychoses, most commonly F29. Girls were moreover younger (mean age = 15.46) than boys (mean age = 16.62) at admission. Girls more often displayed mood symptoms and boys aggressive behaviours, alcohol abuse problems, and isolation. Family adversities recorded as current stressors were more numerous among girls. Girls were more likely to be referred to specialized after-care than boys. CONCLUSIONS The gender differences observed in symptoms presentation are reminiscent of differences encountered in the general adolescent population. Prior to transition to psychosis, girls and boys are equally in contact with psychiatric services due to other (possibly prodromal) symptoms/disorders. Family adversities may be more stressful for girls vulnerable to psychosis than to boys.
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Affiliation(s)
- Sanni Talonen
- a School of Medicine, University of Tampere , Finland
| | - Juha Väänänen
- b Department of Adolescent Psychiatry , Tampere University Hospital , Tampere , Finland
| | - Riittakerttu Kaltiala-Heino
- a School of Medicine, University of Tampere , Finland.,b Department of Adolescent Psychiatry , Tampere University Hospital , Tampere , Finland
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Pina-Camacho L, Garcia-Prieto J, Parellada M, Castro-Fornieles J, Gonzalez-Pinto AM, Bombin I, Graell M, Paya B, Rapado-Castro M, Janssen J, Baeza I, Del Pozo F, Desco M, Arango C. Predictors of schizophrenia spectrum disorders in early-onset first episodes of psychosis: a support vector machine model. Eur Child Adolesc Psychiatry 2015; 24:427-40. [PMID: 25109600 DOI: 10.1007/s00787-014-0593-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/29/2014] [Indexed: 12/21/2022]
Abstract
Identifying early-onset schizophrenia spectrum disorders (SSD) at a very early stage remains challenging. To assess the diagnostic predictive value of multiple types of data at the emergence of early-onset first-episode psychosis (FEP), various support vector machine (SVM) classifiers were developed. The data were from a 2-year, prospective, longitudinal study of 81 patients (age 9-17 years) with early-onset FEP and a stable diagnosis during follow-up and 42 age- and sex-matched healthy controls (HC). The input was different combinations of baseline clinical, neuropsychological, magnetic resonance imaging brain volumetric and biochemical data, and the output was the diagnosis at follow-up (SSD vs. non-SSD, SSD vs. HC, and non-SSD vs. HC). Enhanced recursive feature elimination was performed for the SSD vs. non-SSD classifier to select and rank the input variables with the highest predictive value for a diagnostic outcome of SSD. After validation with a test set and considering all baseline variables together, the SSD vs. non-SSD, SSD vs. HC and non-SSD vs. HC classifiers achieved an accuracy of 0.81, 0.99 and 0.99, respectively. Regarding the SSD vs. non-SSD classifier, a combination of baseline clinical variables (severity of negative, disorganized symptoms and hallucinations or poor insight) and neuropsychological variables (impaired attention, motor coordination, and global cognition) showed the highest predictive value for a diagnostic outcome of SSD. Neuroimaging and biochemical variables at baseline did not add to the predictive value. Thus, comprehensive clinical/cognitive assessment remains the most reliable approach for differential diagnosis during early-onset FEP. SVMs may constitute promising multivariate tools in the search for predictors of diagnostic outcome in FEP.
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Affiliation(s)
- Laura Pina-Camacho
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón. School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Ibiza 43, 28009, Madrid, Spain,
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Díaz-Caneja CM, Pina-Camacho L, Rodríguez-Quiroga A, Fraguas D, Parellada M, Arango C. Predictors of outcome in early-onset psychosis: a systematic review. NPJ SCHIZOPHRENIA 2015; 1:14005. [PMID: 27336027 PMCID: PMC4849440 DOI: 10.1038/npjschz.2014.5] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 01/31/2023]
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.
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Affiliation(s)
- Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - Laura Pina-Camacho
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | - Alberto Rodríguez-Quiroga
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - David Fraguas
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
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Twenty-four months of antipsychotic treatment in children and adolescents with first psychotic episode: discontinuation and tolerability. J Clin Psychopharmacol 2013; 33:463-71. [PMID: 23771198 DOI: 10.1097/jcp.0b013e3182962480] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Child and Adolescent First-Episode Psychosis Study is a longitudinal study of early-onset first psychotic episodes. This report describes the naturalistic psychopharmacological treatment administered during a 24-month follow-up period, as well as discontinuation rates, reasons for discontinuation, and adverse effects. METHODS The sample comprised 110 patients, aged 9 to 17 years, with a first psychotic episode. Pharmacological treatment, changes, reasons for discontinuation, and the UKU (Udvalg for Kliniske Undersogelser) Side Effect Rating Scale were registered at 6, 12, and 24 months of follow-up. RESULTS Second-generation antipsychotics, especially risperidone, quetiapine, and olanzapine, were the most commonly used. The discontinuation rate was 44.5% at 6 months, 59.1% at 12 months, and 70.9% at 24 months. Discontinuation rates or reasons for discontinuation (adverse reaction, insufficient response, and other) did not differ significantly between antipsychotics. At 6 months, significant differences were found in body mass index increase and body mass index z score increase, which were higher with olanzapine, and in neurological effects, which were higher with risperidone; at 12 and 24 months, these differences were no longer significant. High maintenance rates were found in the clozapine group, although they had higher scores on the autonomic subscale of the UKU. CONCLUSIONS A long follow-up period reveals high discontinuation rates similar to those observed in adults, particularly during the first year. No differences were found between antipsychotics. Differences in adverse effects were found at 6 months but not subsequently after changes in treatment. Clozapine had a high maintenance rate, and its tolerability was comparable to that of other antipsychotics.
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Potuzak M, Ravichandran C, Lewandowski KE, Ongür D, Cohen BM. Categorical vs dimensional classifications of psychotic disorders. Compr Psychiatry 2012; 53:1118-29. [PMID: 22682781 PMCID: PMC3488145 DOI: 10.1016/j.comppsych.2012.04.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 04/11/2012] [Accepted: 04/23/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Both categorical and dimensional methods appear relevant to classifying psychotic disorders; however, there is no clear consensus on the most appropriate categories and dimensions or on the best approach for constructing nosologic criteria that integrate these 2 methods. This review examines the evidence on specific dimensions and categories that would best characterize psychoses. METHOD Entries in the MEDLINE database between 1980 and 2011 were searched for studies of the dimensional and/or categorical structure of psychosis. Studies were included if samples represented a spectrum of psychotic disorders and dimensions/categories were empirically derived using principal components analysis, factor analysis, or latent class analysis. RESULTS Most dimensional studies observed 4 or 5 dimensions within psychosis, with positive, negative, disorganization, and affective symptom domains most frequently reported. Substance abuse, anxiety, early onset/developmental, insight, cognition, hostility, and behavioral/social disturbance dimensions appeared in some studies. Categorical studies suggested 3 to 7 major classes within psychosis, including a class similar to Kraepelin's dementia praecox and one or more classes with significant mood components. Only 2 studies compared the relative fit of empirically derived dimensions and categories within the same data set, and each had significant limitations. CONCLUSION There is relatively consistent evidence on appropriate categories and dimensions for characterizing psychoses. However, the lack of studies directly comparing or combining these approaches provides insufficient evidence for definitive conclusions about their relative merits and integration. The authors provide specific recommendations for designing future studies to identify valid dimensions and/or categories of the psychoses and investigate hybrid approaches to model the structure of the underlying illnesses.
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Affiliation(s)
- Melissa Potuzak
- McLean Hospital, Psychotic Disorders Division, Belmont, MA, 02478, USA
| | - Caitlin Ravichandran
- Harvard Medical School, Department of Psychiatry, Boston, MA, 02215, USA,McLean Hospital, Psychiatric Biostatistics Laboratory, Belmont, MA 02478, USA
| | - Kathryn E. Lewandowski
- McLean Hospital, Psychotic Disorders Division, Belmont, MA, 02478, USA,Harvard Medical School, Department of Psychiatry, Boston, MA, 02215, USA
| | - Dost Ongür
- McLean Hospital, Psychotic Disorders Division, Belmont, MA, 02478, USA,Harvard Medical School, Department of Psychiatry, Boston, MA, 02215, USA
| | - Bruce M. Cohen
- McLean Hospital, Psychotic Disorders Division, Belmont, MA, 02478, USA,Harvard Medical School, Department of Psychiatry, Boston, MA, 02215, USA,Corresponding author. Frazier Research Institute, McLean Hospital, 115 Mill Street, Mail Stop 304, Belmont, MA 02474, USA. Tel.: +1 617 855 3227; fax: +1 617 855 3670. (B.M. Cohen)
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11
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Khalid FN, Ford T, Maughan B. Aggressive behaviour and psychosis in a clinically referred child and adolescent sample. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1795-806. [PMID: 22349207 DOI: 10.1007/s00127-012-0480-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 01/25/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite evidence of an increased risk of violence among adults suffering from psychosis, very little is currently known about the relationship between early onset psychosis and aggressive behaviour. We aimed to identify and examine overlaps between aggressive behaviour and psychosis in a referred child and adolescent sample to assess whether potential risk factors and other associated features of this co-occurring pattern can be identified at a young age. METHODS Standardised item sheet data on young people referred to the Child and Adolescent Department of the Maudsley Hospital between 1973 and 2004 were used to contrast three groups: (1) aggressive-only (n = 1,346), (2) psychosis-only (n = 173), and (3) co-occurring aggression and psychosis (n = 39) on a range of comorbid symptoms and potential risk factors. RESULTS Co-occurring cases presented with elevated rates of depersonalisation/derealisation, intrusive thoughts and restlessness, and were more likely to have received past treatment compared with both psychosis-only and aggressive-only cases. Although co-occurring cases resembled the psychosis-only group in many domains, including socio-demographic background and rates of emotional symptoms, they differed from 'pure' psychosis cases in having high levels of special educational needs, irritability, non-aggressive antisocial behaviours, as well as being more likely to be from a low social class and have increased contact with police and child care authorities. CONCLUSIONS Our findings suggest that it is possible to identify early risk factors for aggression in individuals with psychosis.
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Affiliation(s)
- Farah N Khalid
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, 16 De Crespigny Park, Box Number PO46, London SE5 8AF, UK.
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Olfson M, Gerhard T, Huang C, Lieberman JA, Bobo WV, Crystal S. Comparative effectiveness of second-generation antipsychotic medications in early-onset schizophrenia. Schizophr Bull 2012; 38:845-53. [PMID: 21307041 PMCID: PMC3406514 DOI: 10.1093/schbul/sbq172] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2010] [Indexed: 11/14/2022]
Abstract
Scant information exists to guide pharmacological treatment of early-onset schizophrenia. We examine variation across commonly prescribed second-generation antipsychotic medications in medication discontinuation and psychiatric hospital admission among children and adolescents clinically diagnosed with schizophrenia. A 45-state Medicaid claims file (2001-2005) was analyzed focusing on outpatients, aged 6-17 years, diagnosed with schizophrenia or a related disorder prior to starting a new episode of antipsychotic monotherapy with risperidone (n = 805), olanzapine (n = 382), quetiapine (n = 260), aripiprazole (n = 173), or ziprasidone (n = 125). Cox proportional hazard regressions estimated adjusted hazard ratios of 180-day antipsychotic medication discontinuation and 180-day psychiatric hospitalization for patients treated with each medication. During the first 180 days following antipsychotic initiation, most youth treated with quetiapine (70.7%), ziprasidone (73.3%), olanzapine (73.7%), risperidone (74.7%), and aripirazole (76.5%) discontinued their medication (χ(2) = 1.69, df = 4, P = .79). Compared with risperidone, the adjusted hazards of antipsychotic discontinuation did not significantly differ for any of the 4-comparator medications. The percentages of youth receiving inpatient psychiatric treatment while receiving their initial antipsychotic medication ranged from 7.19% (aripiprazole) to 9.89% (quetiapine) (χ(2) = 0.79, df = 4, P = .94). As compared with risperidone, the adjusted hazard ratio of psychiatric hospital admission was 0.96 (95% CI: 0.57-1.61) for olanzapine, 1.03 (95% CI: 0.59-1.81) for quetiapine, 0.85 (95% CI: 0.43-1.70) for aripiprazole, and 1.22 (95% CI: 0.60-2.51) for ziprasidone. The results suggest that rapid antipsychotic medication discontinuation and psychiatric hospital admission are common in the community treatment of early-onset schizophrenia. No significant differences were detected in risk of either adverse outcome across 5 commonly prescribed second-generation antipsychotic medications.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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Memory in Early Onset Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder: Similarities and Differences. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2012; 40:1179-92. [DOI: 10.1007/s10802-012-9631-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ledda MG, Fratta AL, Pintor M, Zuddas A, Cianchetti C. Early-onset psychoses: comparison of clinical features and adult outcome in 3 diagnostic groups. Child Psychiatry Hum Dev 2009; 40:421-37. [PMID: 19280338 DOI: 10.1007/s10578-009-0134-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 02/09/2009] [Indexed: 11/30/2022]
Abstract
A comparison of clinical features and adult outcome in adolescents with three types of psychotic disorders: schizophrenic (SPh), schizoaffective (SA) and bipolar with psychotic features (BPP). Subjects (n = 41) were finally diagnosed (DSM-IV criteria) with SPh (n = 17), SA (n = 11) or BPP (n = 13). Clinical evaluation took place at onset and at a 3-year follow-up in all 41, and at least after 5 years in 36 patients. Symptoms were rated on the basis of the Positive and Negative Syndrome Scale (PANSS), integrating items from the Brief Psychiatric Rating Scale (BPRS) and the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). The Children Global Assessment Scale (C-GAS) and the Global Assessment Scale (GAF) were used to evaluate global functioning. Significant differences in clinical features were found in the three diagnostic groups as regards several parameters, some present on one and not on other rating scales, underscoring the insufficiency of a single scale for accurate analysis of the features of a psychotic disorder. At onset, a comparison using the simple presence/absence of symptoms showed scant differences among groups, while differences emerged if symptom severity was included in the comparison. Functioning at 3- and 5-year follow-ups showed a significantly better outcome in the BPP group and more substantial deterioration, with similar evolution, in the SPh and SA groups. The integration of several rating scales differentiated between diagnostic groups more effectively. The similar adult functioning outcome in the SPh and SA groups showed how difficult it is to clearly separate these two disorders.
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Affiliation(s)
- Maria Giuseppina Ledda
- Clinic of Child and Adolescent Neuropsychiatry, Department of Neurosciences, University of Cagliari, Cagliari, Italy
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Iyer SN, Boekestyn L, Cassidy CM, King S, Joober R, Malla AK. Signs and symptoms in the pre-psychotic phase: description and implications for diagnostic trajectories. Psychol Med 2008; 38:1147-1156. [PMID: 18366823 DOI: 10.1017/s0033291708003152] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Few studies have examined the underlying factor structure of signs and symptoms occurring before the first psychotic episode. Our objective was to determine whether factors derived from early signs and symptoms are differentially associated with non-affective versus affective psychosis. METHOD A principal components factor analysis was performed on early signs and symptoms reported by 128 individuals with first-episode psychosis. Factor scores were examined for their associations with duration of untreated illness, drug abuse prior to onset of psychosis, and diagnosis (schizophrenia versus affective psychosis). RESULTS Of the 27 early signs and symptoms reported by patients, depression and anxiety were the most frequent. Five factors were identified based on these early signs and symptoms: depression, disorganization/mania, positive symptoms, negative symptoms and social withdrawal. Longer duration of untreated illness was associated with higher levels of depression and social withdrawal. Individuals with a history of drug abuse prior to the onset of psychosis scored higher on pre-psychotic depression and negative symptoms. The two mood-related factors, depression and disorganization/mania, distinguished the eventual first-episode diagnosis of affective psychosis from schizophrenia. Individuals with affective psychosis were also more likely to have a 'mood-related' sign and symptom as their first psychiatric change than individuals later diagnosed with schizophrenia. CONCLUSIONS Factors derived from early signs and symptoms reported by a full diagnostic spectrum sample of psychosis can have implications for future diagnostic trajectories. The findings are a step forward in the process of understanding and characterizing clinically important phenomena to be observed prior to the onset of psychosis.
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Affiliation(s)
- S N Iyer
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
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Fraguas D, de Castro MJ, Medina O, Parellada M, Moreno D, Graell M, Merchán-Naranjo J, Arango C. Does diagnostic classification of early-onset psychosis change over follow-up? Child Psychiatry Hum Dev 2008; 39:137-45. [PMID: 17665305 DOI: 10.1007/s10578-007-0076-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 07/16/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the diagnostic stability and the functional outcome of patients with early-onset psychosis (EOP) over a 2-year follow-up period. METHODS A total of 24 patients (18 males (75%) and 6 females (25%), mean age +/- SD: 15.7 +/- 1.6 years) with a first episode of EOP formed the sample. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Social disability was measured with the Global Assessment of Functioning (GAF) disability scale. Diagnosis was assessed using the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL), according to DSM-IV criteria. All diagnoses were re-assessed after 1 year and 2 years. RESULTS Schizophrenia had the highest prospective consistency (100% predictive value), while diagnostic stability was moderate for bipolar disorder (71.4%), and low for schizoaffective disorder (50%), schizophreniform and brief psychosis (50%), and psychosis not otherwise specified (NOS) (16.7%). The agreement between the baseline diagnoses and the 1-year follow-up diagnoses was 54.2%, whereas between the 1-year follow-up and the 2-year follow-up, it rose to 95.7%. Regardless of diagnosis, baseline negative symptoms were the only significant predictor of level of functioning at the 2-year follow-up (p = 0.010). CONCLUSION Our results highlight the primacy of the first-year follow-up diagnosis in predicting diagnostic stability of EOP.
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Affiliation(s)
- David Fraguas
- Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Ibiza 43, CP 28009, Madrid, Spain.
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Muhlbauer S. Caregiver perceptions and needs regarding symptom attenuation in severe and persistent mental illness. Perspect Psychiatr Care 2008; 44:99-109. [PMID: 18366364 DOI: 10.1111/j.1744-6163.2008.00159.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the experience of caretakers who are coping with treated yet impaired mentally ill family members. Needs of the caretaker were described and areas for intervention were identified. DESIGN AND METHODS This qualitative study used the symbolic interaction paradigm of dramaturgical interviewing. Thirty-five caretakers participated in a 1.5- to 2-hr semistructured interview. FINDINGS Themes related to long-term effects of positive and negative symptoms and issues about accountability, responsibility, and planning for the future were most prominent. PRACTICE IMPLICATIONS Areas of intervention were identified as recognition and management of negative symptoms and counseling related to issues of accountability, responsibility, and future planning.
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Affiliation(s)
- Susan Muhlbauer
- University of Nebraska Medical Center College of Nursing, Nebraska Medical Center, Omaha, NE, USA.
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Frazier JA, McCLELLAN J, Findling RL, Vitiello B, Anderson R, Zablotsky B, Williams E, McNAMARA NK, Jackson JA, Ritz L, Hlastala SA, Pierson L, Varley JA, Puglia M, Maloney AE, Ambler D, Hunt-Harrison T, Hamer RM, Noyes N, Lieberman JA, Sikich L. Treatment of early-onset schizophrenia spectrum disorders (TEOSS): demographic and clinical characteristics. J Am Acad Child Adolesc Psychiatry 2007; 46:979-988. [PMID: 17667477 DOI: 10.1097/chi.0b013e31807083fd] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We examined baseline demographic and clinical profiles of youths enrolled from 2001 to 2006 in the publicly funded multicenter, randomized controlled trial Treatment of Early-Onset Schizophrenia Spectrum Disorders. METHOD Youths (8-19 years) with schizophrenia (SZ) and schizoaffective disorder were recruited at four academic sites. Diagnosis was made via structured and clinical interviews. Assessments of psychiatric symptoms and social and global functioning were included. RESULTS A total of 119 youths were enrolled. The mean age at illness onset was 11.1 +/- 3.5 years. Patients with SZ and schizoaffective disorder had similar ratings on the Positive and Negative Symptom Scale, Brief Psychiatric Rating Scale for Children, and Clinical Global Impression-Severity Scale. The overall level of functioning was similar in the two groups. A comparison to published reports of adults with SZ indicates that these youths may have more severe symptoms based on results of the Positive and Negative Symptom Scale. CONCLUSIONS This is one of the largest samples of youths with SZ spectrum disorders studied to date and the largest assessment of youths with schizoaffective disorder. High rates of symptoms and general psychopathology were noted. There was a substantial degree of social and functional impairment. The symptom profiles are consistent with, but more severe than, those reported in the adult literature.
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Affiliation(s)
- Jean A Frazier
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill..
| | - Jon McCLELLAN
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Robert L Findling
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Benedetto Vitiello
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Robert Anderson
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Benjamin Zablotsky
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Emily Williams
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Nora K McNAMARA
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Joseph A Jackson
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Louise Ritz
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Stefanie A Hlastala
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Leslie Pierson
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Jennifer A Varley
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Madeline Puglia
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Ann E Maloney
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Denisse Ambler
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Tyehimba Hunt-Harrison
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Robert M Hamer
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Nancy Noyes
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Jeffrey A Lieberman
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Linmarie Sikich
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
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Troisi A, Pompili E, Binello L, Sterpone A. Facial expressivity during the clinical interview as a predictor functional disability in schizophrenia. a pilot study. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:475-81. [PMID: 17188789 DOI: 10.1016/j.pnpbp.2006.11.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2006] [Revised: 11/11/2006] [Accepted: 11/14/2006] [Indexed: 10/23/2022]
Abstract
Despite the central role of nonverbal behavior in regulating social interactions, its relationship to functional disability in schizophrenia has received little empirical attention. This study aimed at assessing the relationship of patients' spontaneous facial expressivity during the clinical interview to clinician-rated and self-reported measures of functional disability. The nonverbal behavior of 28 stabilized patients with schizophrenia was analyzed by using the Ethological Coding System for Interviews (ECSI). Functional disability was assessed using the Global Assessment of Functioning (GAF) scale and the Sheehan Disability Scale (DISS). Partial correlation analysis controlling for the confounding effects of neuroleptic treatment showed that facial expressivity was correlated with the GAF score (r=0.42, P=0.03) and the scores on the subscales of the DISS measuring work (r=-0.52, P=0.005) and social (r=-0.50, P=0.007) disability. In a multiple regression model, nonverbal behavior explained variation in patients' work and social disability better than negative symptoms. The results of this pilot study suggest that deficits in encoding affiliative signals may play a role in determining or aggravating functional disability in schizophrenia. One clinical implication of this finding is that remediation training programs designed to improve nonverbal communication could also serve as a useful adjunct for improving work and social functioning in patients with schizophrenia.
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Affiliation(s)
- Alfonso Troisi
- Department of Neurosciences, University of Rome Tor Vergata, via G.A. Guattani, 00161, Rome, Italy.
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Castro-Fornieles J, Parellada M, Gonzalez-Pinto A, Moreno D, Graell M, Baeza I, Otero S, Soutullo CA, Crespo-Facorro B, Ruiz-Sancho A, Desco M, Rojas-Corrales O, Patiño A, Carrasco-Marin E, Arango C. The child and adolescent first-episode psychosis study (CAFEPS): design and baseline results. Schizophr Res 2007; 91:226-37. [PMID: 17267179 DOI: 10.1016/j.schres.2006.12.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 11/26/2006] [Accepted: 12/09/2006] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The child and adolescent first-episode psychosis study (CAFEPS) is a multicenter, two-year, longitudinal project aiming to evaluate different clinical, neuropsychological, neuroimaging, biochemical, immunological, and genetic variables and treatment and prognostic factors in these patients. This paper describes the methods and rationale behind the study and the general characteristics of the sample. METHOD At six different centers, from March 2003 through November 2005, we consecutively recruited 110 patients, ages 9-17 years, who presented with a first psychotic episode. Controls were recruited from the same geographic areas and were matched for gender and age. RESULTS Patients had lower socioeconomic status (SES) (p=0.018) and parental years of education (p<0.001) than controls. The percentage of patients recruited increased with age (p<0.001) and there was a higher percentage of males (p<0.001). The total mean PANSS score was 89.03+/-20.1, the positive score 23.8+/-6.5 and the negative score 20.02+/-8.8. There were no significant differences between the genders with respect to age, parental years of education, SES, or scores in premorbid adjustment or general functioning. There were statistically significant positive correlations between age and positive symptoms and between all PANSS subscales and the Disability Assessment Schedule, and negative correlations between positive symptoms and global functioning. Diagnoses after the baseline evaluation were: psychotic disorder not otherwise specified (NOS) 35.5%, schizophreniform disorder 24.5%, mood disorder with psychotic symptoms 22.7%, schizophrenia 10%, schizoaffective disorder 2.7%, and other psychotic disorders 4.5%. Patients had worse premorbid adjustment (p<0.001) and global functioning (p<0.001) than controls after controlling for SES. CONCLUSIONS Infancy and adolescence adjustment and global functioning are lower in children and adolescents with psychotic disorders than in controls, severity of symptoms are related to general disability, and the most frequent diagnoses are psychotic disorders NOS.
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Affiliation(s)
- Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic of Neurosciences, Institut d'Investigacions Biomèdiques August Pi Sunyer, Hospital Clínic Universitari of Barcelona, Villarroel, Spain.
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Pagsberg AK, Baaré WFC, Raabjerg Christensen AM, Fagerlund B, Hansen MB, Labianca J, Krabbe K, Aarkrog T, Paulson OB, Hemmingsen RP. Structural brain abnormalities in early onset first-episode psychosis. J Neural Transm (Vienna) 2006; 114:489-98. [PMID: 17024324 DOI: 10.1007/s00702-006-0573-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 08/27/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Brain morphometry in children and adolescents with first-episode psychosis offer a unique opportunity for pathogenetic investigations. METHODS We compared high-resolution 3D T1-weighted magnetic resonance images of the brain in 29 patients (schizophrenia, schizotypal disorder, delusional disorder or other non-organic psychosis), aged 10-18 to those of 29 matched controls, using optimized voxel-based morphometry. RESULTS Psychotic patients had frontal white matter abnormalities, but expected (regional) gray matter reductions were not observed. Post hoc analyses revealed that schizophrenia patients (n = 15) had significantly larger lateral ventricles as compared to controls. Duration and dose of antipsychotics correlated negatively with global gray matter volume in minimally medicated patients (n = 18). CONCLUSION Findings of white matter changes and enlarged lateral ventricles already at illness onset in young schizophrenia spectrum patients, suggests aberrant neurodevelopmental processes in the pathogenesis of these disorders. Gray matter volume changes, however, appear not to be a key feature in early onset first-episode psychosis.
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Affiliation(s)
- A K Pagsberg
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.
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22
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Shannon JC, McClellan J. Early onset schizophrenia: diagnostic dilemmas and treatment challenges. ACTA ACUST UNITED AC 2004. [DOI: 10.2217/14750708.1.1.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Roberts DL, Penn DL, Cather C, Otto M, Goff DC. Should CBT Target the Social Impairments Associated With Schizophrenia? J Cogn Psychother 2004. [DOI: 10.1891/jcop.18.3.255.65651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Adjunctive cognitive behavior therapy (CBT) has been found to reduce the impact of symptoms among individuals with schizophrenia; however, CBT has not been used to address the social deficits in this clinical population. The current article elaborates the rationale for targeting social functioning with CBT. These reasons include the following: (a) Social dysfunction is a core feature of schizophrenia that is not directly improved with medication; (b) Improved social functioning is a treatment goal of many patients with schizophrenia, and thus treatments designed to improve social functioning may increase treatment motivation and reduce attrition; (c) Adaptive social functioning is a critical component of mental and physical health; and (d) Social dysfunction appears to be responsive to psychosocial intervention. This article concludes with a description of functional cognitive behavior therapy (FCBT), a CBT intervention that has been developed with enhanced focus on social impairments.
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Sikich L, Hamer RM, Bashford RA, Sheitman BB, Lieberman JA. A pilot study of risperidone, olanzapine, and haloperidol in psychotic youth: a double-blind, randomized, 8-week trial. Neuropsychopharmacology 2004; 29:133-45. [PMID: 14583740 DOI: 10.1038/sj.npp.1300327] [Citation(s) in RCA: 237] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This pilot study was undertaken to estimate the acute antipsychotic effect size and side effect propensity of risperidone and olanzapine in the pediatric population, in comparison to haloperidol, a conventional antipsychotic with established efficacy. Risperidone and olanzapine are widely used as first-line treatments to ameliorate psychotic symptoms in youth, but their abilities to specifically treat children and adolescents presenting due to psychotic symptoms have not been rigorously studied. Subjects, selected because of prominent positive psychotic symptoms, were randomly assigned to double-blind, parallel treatment with risperidone, olanzapine, or haloperidol for 8 weeks. The primary outcome was reduction in the Brief Psychiatric Rating Scale for Children total score from baseline to termination. An exploratory, descriptive analysis was done to compare the three treatments. A total of 50 patients, 8-19 years, participated. All treatments reduced symptoms significantly with p-values (corrected for multiple comparisons) of 0.0018 for each of the atypical agents and 0.012 for haloperidol. In all, 88% of subjects treated with olanzapine, 74% treated with risperidone, and 53% treated with haloperidol met response criteria. The primary side effects observed in all patients were mild to moderate sedation, extrapyramidal symptoms, and weight gain. Risperidone and olanzapine acutely reduced psychotic symptoms in this pediatric sample. Exploratory comparisons indicate the magnitude of the antipsychotic response with these atypical agents is comparable to that observed with haloperidol. However, youth treated with risperidone and olanzapine experienced weight gain and extrapyramidal effects that appear more prevalent and severe than reported in adults.
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Affiliation(s)
- Linmarie Sikich
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7160, USA.
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Groisman AE, Seminatore ML. Children and adolescents who have schizophrenia. Pediatr Rev 2003; 24:356-7; discussion 356-7. [PMID: 14523163 DOI: 10.1542/pir.24-10-356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Adriana E Groisman
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Abstract
Psychosis in children and adolescents is a relatively rare entity, with a plethora of possible origins. Appropriate evaluation and treatment can stem only from a complete understanding of the differential diagnosis of psychotic presentations in children. Once the acute presentation is stabilized and the cause for the psychosis accurately identified, the child can be referred appropriately to ongoing psychiatric care or substance abuse treatment, or he or she can be handed over to another medical specialty to further treat the underlying cause when there is a medical cause for the psychosis.
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Affiliation(s)
- Thomas F Semper
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington, 4800 Sand Point Way Northeast, Mail Stop 6F-1, Seattle, WA 98105, USA.
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McClellan J, Breiger D, McCurry C, Hlastala SA. Premorbid functioning in early-onset psychotic disorders. J Am Acad Child Adolesc Psychiatry 2003; 42:666-72. [PMID: 12921474 DOI: 10.1097/01.chi.0000046844.56865.6b] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the premorbid characteristics of youths with early-onset psychotic disorders. METHOD Subjects with early-onset psychotic disorders received an extensive diagnostic evaluation upon entry into the study, including a historic review of premorbid functioning using the Premorbid Adjustment Scale. RESULTS Youths with schizophrenia (n = 27), bipolar disorder (n = 22), and psychosis not otherwise specified (NOS) (n = 20) were included. High rates of premorbid behavioral problems and academic difficulties were noted across all subjects. Youths with schizophrenia had higher rates of premorbid social withdrawal and global impairment. They also tended to have fewer friends. The psychosis NOS group had significantly higher rates of abuse histories and posttraumatic stress disorder. CONCLUSIONS Premorbid abnormalities are common features of early-onset psychotic disorders. The social withdrawal and peer problems specific to youths with schizophrenia likely represent early manifestations of negative symptoms. The abuse histories in the psychosis NOS group may explain the atypical nature of their reported psychotic symptoms, which in many cases are likely posttraumatic phenomena.
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Affiliation(s)
- Jon McClellan
- Department of Psychiatry, University of Washington, Seattle 98195, USA.
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