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Herwerth L, Prinz K, Brauner H, Müller K, Fleischhaker C. Psychosen aus dem schizophrenen Formenkreis im Jugendalter: Einflussfaktoren auf Neuropsychologie, Behandlungserfolg und Negativsymptomatik. ZEITSCHRIFT FÜR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2022; 51:196-206. [PMID: 36205021 DOI: 10.1024/1422-4917/a000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Zusammenfassung. Fragestellung: Ziel der vorliegenden Studie war es, Einflussfaktoren auf den Erkrankungsverlauf von Kindern und Jugendlichen mit der Diagnose einer Psychose aus dem schizophrenen Formenkreis in einer stationären Eingliederungsmaßnahme zu untersuchen. Methodik: 33 Patient_innen (Durchschnittsalter 19.4 Jahre, SD = 2.3), davon 12 (36 %) weiblich, nahmen teil. Diese wurden mit klinischen Interviews (IRAOS, SANS/SAPS), neuropsychologischen Tests (WAIS-IV, TMT) und Fragebögen (FBB, BSCL) untersucht. Ergebnis: Korreliert waren das neuropsychologische Funktionsniveau und die prämorbide kognitive Leistungsfähigkeit, ebenso der Behandlungserfolg aus Patientensicht und eine gute Beziehung zum Therapeuten bzw. zur Therapeutin, außerdem eine stärkere Negativsymptomatik mit einer längeren Dauer der unbehandelten Psychose (DUP) und einem längeren ersten Krankenhausaufenthalt. Schlussfolgerung: Mögliche Ansatzpunkte zur besseren Behandlung von Jugendlichen mit Psychosen aus dem schizophrenen Formenkreis stellen eine Verkürzung der DUP und eine gute therapeutische Beziehung dar.
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Affiliation(s)
- Lisette Herwerth
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik im Kindes- und Jugendalter, Universitätsklinikum Freiburg, Deutschland
- Geteilte Erstautorenschaft
| | - Katharina Prinz
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik im Kindes- und Jugendalter, Universitätsklinikum Freiburg, Deutschland
- Geteilte Erstautorenschaft
| | - Heike Brauner
- Psychotherapeutisches Wohnheim für junge Menschen Leppermühle, Buseck bei Gießen, Deutschland
| | - Katarina Müller
- Psychotherapeutisches Wohnheim für junge Menschen Leppermühle, Buseck bei Gießen, Deutschland
| | - Christian Fleischhaker
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik im Kindes- und Jugendalter, Universitätsklinikum Freiburg, Deutschland
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Bozzatello P, Giordano B, Montemagni C, Rocca P, Bellino S. Real-World Functioning in Psychiatric Outpatients: Predictive Factors. J Clin Med 2022; 11:jcm11154400. [PMID: 35956015 PMCID: PMC9369214 DOI: 10.3390/jcm11154400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/17/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Investigations on predictors of real-world functioning were mainly performed in patients with schizophrenia, while fewer studies have been conducted in other psychiatric disorders. Objective: Our objective was to identify clinical, socio-demographic, and illness-related predictors of real-world functioning during 12 months of standard treatments in outpatients with different diagnoses. Methods: Outpatients (n = 1019) with schizophrenia (SZ), major depressive disorder (MDD), bipolar disorder (BD), and borderline personality disorder (BPD) were evaluated with the following tools: SCID-5-CV and SCID-5-PD, CGI-S, SAT-P, DAI-10, and PSP. Change of PSP (ΔPSP) between baseline and 12 months was used as the dependent variable in multiple regression analysis. Results: Higher PSP score at baseline and the achievement of main milestones predicted better functioning after follow-up in all subgroups of patients, with the exception of BD. In the total sample, ΔPSP was related to age of onset, treatments, and quality of life, and inversely related to psychiatric anamnesis, antidepressants, and global symptoms. In SZ, ΔPSP was related to adherence and quality of life. In MDD, ΔPSP was related to psychotherapy and quality of life, and inversely related to antidepressants and global symptoms. In BD, ΔPSP was related to age of onset, antipsychotics, and quality of life, while it was inversely related to psychiatric anamnesis. In BPD, antipsychotics, mood stabilizers, psychotherapy, and quality of life were directly related to ΔPSP, while suicidal attempts and global symptoms had an inverse relation. Conclusions: Several socio-demographic and illness-related variables predicted improvement of real-world functioning, besides psychopathology and severity of the disease.
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Huxley P, Krayer A, Poole R, Prendergast L, Aryal S, Warner R. Schizophrenia outcomes in the 21st century: A systematic review. Brain Behav 2021; 11:e02172. [PMID: 33991072 PMCID: PMC8213926 DOI: 10.1002/brb3.2172] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/16/2021] [Accepted: 04/23/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE We report a review of outcomes in schizophrenia in the twenty-first century, replicating and extending work undertaken by the late Richard Warner in his seminal book, "Recovery from Schizophrenia: Psychiatry and Political Economy" (1985;2004). METHOD Warner's methods were followed as closely as possible. Only observational/naturalistic studies were included. Six scientific databases were searched from 2000 to 2020. 6,640 records were retrieved. 47 met inclusion criteria. RESULTS Overall, complete recovery is higher in this study than in Warner's (37.75% cf 20.4%), especially for first episode psychosis (FEP) (57.1% cf 20.7%). Clinical recovery, annualized remission rate (ARR), and employment outcomes were significantly superior for first episode psychosis compared with multiple episode psychosis (MEP). ARR shows a trend toward reduction over time, from 2.2 before the financial crash of 2008 to 1.6 after (t = 1.85 df 40 p = .07). The decline is statistically significant for the MEP group (t = 2.32 df18 p = .03). There were no differences in outcome by region, sample characteristics, outcome measures used, or quality of studies. Heterogeneity of clinical outcome measures across the literature makes evidence synthesis difficult. Weak and inconsistent reporting of functional and employment outcomes mean that findings lack meaning with respect to lived experience. CONCLUSION Future research strategies should aim to reduce heterogeneity in clinical outcome measures and to increase the emphasis on capture and reporting of more sophisticated measures of social and functional outcome. Outcome domains should be disaggregated rather than conflated into unitary recovery constructs.
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Affiliation(s)
- Peter Huxley
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Anne Krayer
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Rob Poole
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Louise Prendergast
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Sanjaya Aryal
- Department of Sociology, University of Essex, Colchester, UK
| | - Richard Warner
- Clinical Professor of Psychiatry and Adjunct Professor of Anthropology, University of Colorado, Denver, CO, USA
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Pontillo M, Averna R, Tata MC, Chieppa F, Pucciarini ML, Vicari S. Neurodevelopmental Trajectories and Clinical Profiles in a Sample of Children and Adolescents With Early- and Very-Early-Onset Schizophrenia. Front Psychiatry 2021; 12:662093. [PMID: 34603093 PMCID: PMC8481627 DOI: 10.3389/fpsyt.2021.662093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022] Open
Abstract
Schizophrenia before the age of 18 years is usually divided into two categories. Early-onset schizophrenia (EOS) presents between the ages of 13 and 17 years, whereas very-early-onset schizophrenia (VEOS) presents at or before the age of 12 years. Previous studies have found that neurodevelopmental difficulties in social, motor, and linguistic domains are commonly observed in VEOS/EOS patients. Recent research has also shown a high prevalence of neurodevelopmental disorders (e.g., intellectual disability, communication disorders, autism spectrum disorder, neurodevelopmental motor disorders) in VEOS/EOS patients, indicating genetic overlap between these conditions. These findings lend support to the neurodevelopmental continuum model, which holds that childhood neurodevelopmental disorders and difficulties and psychiatric disorders (e.g., schizophrenia) fall on an etiological and neurodevelopmental continuum, and should not be considered discrete entities. Based on this literature, in this study we focused on the overlap between neurodevelopmental disorders and schizophrenia investigating, in a large sample (N = 230) of VEOS/EOS children and adolescents, the clinical differences, at the onset of psychosis, between VEOS/EOS with neurodevelopmental disorder or neurodevelopmental difficulties and VEOS/EOS with no diagnosed neurodevelopmental disorder or neurodevelopmental difficulties. The findings showed that, in children and adolescents with a neurodevelopmental disorder or neurodevelopmental difficulties, psychosis onset occurred at an earlier age, was associated with more severe functional impairment (e.g., global, social, role), and was characterized by positive symptoms (e.g., grandiose ideas, perceptual abnormalities, disorganized communication) and disorganized symptoms (e.g., odd behavior or appearance, bizarre thinking). Instead, in children and adolescents without a neurodevelopmental disorder or neurodevelopmental difficulties, psychosis onset was mainly characterized by negative symptomatology (e.g., social anhedonia, avolition, expression of emotion, experience of emotions and self, ideational richness). Given these differences, the presence of a neurodevelopmental disorder or neurodevelopmental difficulties should be carefully investigated and integrated early into the assessment and treatment plan for VEOS/EOS patients.
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Affiliation(s)
- Maria Pontillo
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Roberto Averna
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Maria Cristina Tata
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Fabrizia Chieppa
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Laura Pucciarini
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.,Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, Rome, Italy
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5
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Liangrong Z, Guican Z, Qi Z, Weirui Y, Yaqi Z, Tong L, Wenjing L, Ming Z, Nianhong G. Long-Term Outcomes and Predictors of Childhood-Onset Schizophrenia: A Naturalistic Study of 6-year Follow-Up in China. Front Psychiatry 2021; 12:679807. [PMID: 34393845 PMCID: PMC8360848 DOI: 10.3389/fpsyt.2021.679807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/30/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: The long-term outcome of childhood-onset schizophrenia (COS) and its influencing factors remain unclear. The current study aimed to assess the long-term outcomes of COS and identify possible outcome predictors. Methods: We retrospectively investigated 276 patients with COS. Diagnosis made according to the ICD-10 criteria for schizophrenia, and the age of the first onset was ≤ 14 years. Follow-up was completed for 170 patients, with a median follow-up period of 5.6 years. Outcome variables included occupational/education status and readmission. Spearman correlation was performed to assess the relationship between predictors and outcome variables. Binary logistic regression was conducted to detect possible predictor variables for outcome variables. Results: At the end of the follow-up, 89 patients (52.3%) were at school, 70 patients (41.2%) were employed, and only 11 patients (6.5%) were dropped out of school or unemployed. The duration to the first admission and depressive symptoms were identified as predictors of occupational/educational status. The length of follow-up and obsessive-compulsive symptoms (OCS) were distinguished as predictors of readmission. Duration to the first admission and length of follow-up were risk factors, and depressive symptoms and OCS were protective factors for the outcomes of COS. Conclusion: We found a favorable long-term outcome on occupational/education status in COS, and depressive symptoms and OCS may be associated with more positive long-term outcomes in COS. Our findings suggest that COS patients may benefit from early intervention and require appropriate treatment.
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Affiliation(s)
- Zheng Liangrong
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhang Guican
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhu Qi
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yang Weirui
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhang Yaqi
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Tong
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liang Wenjing
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhang Ming
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guan Nianhong
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Shirk D, Horn S, Williams SD, Lagman JG. Lack of Resources for Aftercare for Children With Psychosis: A System’s Failure. Cureus 2020; 12:e12076. [PMID: 33489494 PMCID: PMC7805532 DOI: 10.7759/cureus.12076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Very early-onset schizophrenia (VEOS) is a rare disorder that is associated with poor outcomes, especially with securing aftercare plans that will lead to stabilization of illness and prevent recidivism. There is a scarcity of resources available to patients with VEOS and their families once they leave inpatient treatment to achieve long-term success. Here we report a case of a 12-year-old-female who was diagnosed with VEOS at age 11 and since that diagnosis has struggled with finding appropriate resources to meet her needs, requiring frequent hospitalizations and displaying a continued decline in functioning.
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Temesgen WA, Chien WT, Bressington D. Conceptualizations of subjective recovery from recent onset psychosis and its associated factors: A systematic review. Early Interv Psychiatry 2019; 13:181-193. [PMID: 29927071 DOI: 10.1111/eip.12698] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 02/27/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Abstract
AIM There is no standard definition of "subjective recovery" from psychosis, its nature is currently contested and debated among service-users and professionals. Individual studies have explored conceptualizations of subjective recovery from recent onset psychosis, but there have been no previously published systematic reviews on the topic. The aim of this review was to examine and synthesize quantitative and qualitative studies examining the concept of subjective recovery from recent onset psychosis and identify common factors associated with this recovery process. METHODS Relevant electronic databases (Medline, CINAHL, PsychInfo and ProQuest Dissertations and Theses) were searched and hand searches were also carried out. Publications in each database from the inceptions of the databases to April 12, 2017 were included. Data from selected articles were extracted using a piloted extraction form and thematic integrative analysis was performed. RESULTS Ten studies with different study designs were included in this review. Subjective recovery was conceptualized into 3 main themes: "recovery as outcome", "recovery as process" and "endeavours during recovery". Factors contributing to subjective recovery were categorized into 4 main themes; "treatment related", "illness related", "individual related" and "social environment" related. Non-linear and subjective nature of the process of recovery were reinforced by the review findings. CONCLUSIONS Studies in subjective recovery from recent onset psychosis are limited to developed countries. Acquiring hope and self-confidence, overcoming symptoms and stigma through mobilizing all resources available were accentuated in conceptualizing subjective recovery and related factors. Recovery-oriented health care services should acknowledge individual differences and involve service users in their care decisions.
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Affiliation(s)
- Worku A Temesgen
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Wai Tong Chien
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Daniel Bressington
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
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Kang C, Zhou H, Yang J, Yang R, Sun N, Wang S, Yang C, Han D, Srihari VH. Course, outcome and diagnosis stability of early-onset schizophrenia in Yunnan Province, China-a three years follow-up study. Psychiatry Res 2019; 271:144-149. [PMID: 30472510 DOI: 10.1016/j.psychres.2018.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 10/07/2018] [Accepted: 11/06/2018] [Indexed: 11/16/2022]
Abstract
The aim of the study was to describe diagnostic stability and psychosocial outcomes of subjects with early-onset schizophrenia (EOS). All the subjects who had been hospitalized in the Department of Psychiatry of the First Affiliated Hospital of Kunming Medical University between January 2011 and July 2015 with the diagnosis of International Classification of Diseases (ICD)-10 defined schizophrenia, and discharged from the hospital for more than 12 months were enrolled to the study. The Mini International Neuropsychiatric Interview was applied for life-time ICD -10 diagnoses, and Personal and Social Performance (PSP) for global function evaluation. Altogether 249 patients were targeted for follow-up, in which 101 were followed up and the dropout rate was 59.4%. After average 37.2 ± 16.2 months, 92 patients (including 1 death) were still met the ICD-10 diagnosis of schizophrenia (F20). In terms of global functioning, 48.5% of patients had good outcome, 43.6% had moderate outcome, and 7.9% had poor outcome. A relatively high diagnostic stability of ICD-10 defined schizophrenia was obtained in the current study .Moreover, our results draw a much more optimistic picture of the outcome for EOS than what has previously been reported from Western counties.
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Affiliation(s)
- Chuanyuan Kang
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; Department of Psychosomatic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China.
| | - Huizhi Zhou
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Jianzhong Yang
- Department of Psychiatry, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Runxu Yang
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Ning Sun
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Shaohua Wang
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Chen Yang
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Dong Han
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Vinod H Srihari
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06519, USA
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Downs J, Dean H, Lechler S, Sears N, Patel R, Shetty H, Hotopf M, Ford T, Kyriakopoulos M, Diaz-Caneja CM, Arango C, MacCabe JH, Hayes RD, Pina-Camacho L. Negative Symptoms in Early-Onset Psychosis and Their Association With Antipsychotic Treatment Failure. Schizophr Bull 2019; 45:69-79. [PMID: 29370404 PMCID: PMC6293208 DOI: 10.1093/schbul/sbx197] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The prevalence of negative symptoms (NS) at first episode of early-onset psychosis (EOP), and their effect on psychosis prognosis is unclear. In a sample of 638 children with EOP (aged 10-17 y, 51% male), we assessed (1) the prevalence of NS at first presentation to mental health services and (2) whether NS predicted eventual development of multiple treatment failure (MTF) prior to the age of 18 (defined by initiation of a third trial of novel antipsychotic due to prior insufficient response, intolerable adverse-effects or non-adherence). Data were extracted from the electronic health records held by child inpatient and community-based services in South London, United Kingdom. Natural Language Processing tools were used to measure the presence of Marder Factor NS and antipsychotic use. The association between presenting with ≥2 NS and the development of MTF over a 5-year period was modeled using Cox regression. Out of the 638 children, 37.5% showed ≥2 NS at first presentation, and 124 (19.3%) developed MTF prior to the age of 18. The presence of NS at first episode was significantly associated with MTF (adjusted hazard ratio 1.62, 95% CI 1.07-2.46; P = .02) after controlling for a number of potential confounders including psychosis diagnostic classification, positive symptoms, comorbid depression, and family history of psychosis. Other factors associated with MTF included comorbid autism spectrum disorder, older age at first presentation, Black ethnicity, and family history of psychosis. In EOP, NS at first episode are prevalent and may help identify a subset of children at higher risk of responding poorly to antipsychotics.
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Affiliation(s)
- Johnny Downs
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK,South London and Maudsley NHS Foundation Trust, UK,Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King’s College London, UK
| | - Harry Dean
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK
| | - Suzannah Lechler
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK
| | - Nicola Sears
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK
| | - Rashmi Patel
- South London and Maudsley NHS Foundation Trust, UK,Department of Psychosis Studies, Institute of Psychiatry Psychology Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK
| | | | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK,South London and Maudsley NHS Foundation Trust, UK
| | | | - Marinos Kyriakopoulos
- South London and Maudsley NHS Foundation Trust, UK,Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King’s College London, UK,Department of Psychiatry, Icahn School of Medicine at Mount Sinai
| | - Covadonga M Diaz-Caneja
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Spain
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Spain
| | - James H MacCabe
- South London and Maudsley NHS Foundation Trust, UK,Department of Psychosis Studies, Institute of Psychiatry Psychology Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK
| | - Richard D Hayes
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King’s College London & NIHR South London and Maudsley Biomedical Research Centre, UK
| | - Laura Pina-Camacho
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King’s College London, UK,Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Spain,To whom correspondence should be addressed; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Ibiza 43, 28009 Madrid, Spain; tel: +34-914265005, fax: +34-914265004, e-mail:
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10
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Lally J, Ajnakina O, Stubbs B, Cullinane M, Murphy KC, Gaughran F, Murray RM. Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies. Br J Psychiatry 2017; 211:350-358. [PMID: 28982659 DOI: 10.1192/bjp.bp.117.201475] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/06/2017] [Accepted: 06/10/2017] [Indexed: 01/17/2023]
Abstract
BackgroundRemission and recovery rates for people with first-episode psychosis (FEP) remain uncertain.AimsTo assess pooled prevalence rates of remission and recovery in FEP and to investigate potential moderators.MethodWe conducted a systematic review and meta-analysis to assess pooled prevalence rates of remission and recovery in FEP in longitudinal studies with more than 1 year of follow-up data, and conducted meta-regression analyses to investigate potential moderators.ResultsSeventy-nine studies were included representing 19072 patients with FEP. The pooled rate of remission among 12301 individuals with FEP was 58% (60 studies, mean follow-up 5.5 years). Higher remission rates were moderated by studies from more recent years. The pooled prevalence of recovery among 9642 individuals with FEP was 38% (35 studies, mean follow-up 7.2 years). Recovery rates were higher in North America than in other regions.ConclusionsRemission and recovery rates in FEP may be more favourable than previously thought. We observed stability of recovery rates after the first 2 years, suggesting that a progressive deteriorating course of illness is not typical. Although remission rates have improved over time recovery rates have not, raising questions about the effectiveness of services in achieving improved recovery.
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Affiliation(s)
- John Lally
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Olesya Ajnakina
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Michael Cullinane
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kieran C Murphy
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Fiona Gaughran
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robin M Murray
- John Lally, MB MSc MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK, and Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland, and Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, St Vincent's University Hospital, Dublin, Ireland; Olesya Ajnakina, MSc PhD, Department of Psychosis Studies, IoPPN, King's College London, London, UK; Brendon Stubbs, MSc MCSP PhD, Health Service and Population Research Department, IoPPN, King's College London, and Physiotherapy Department, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK; Michael Cullinane, MB MRCPsych, Young Adult Mental Health Services, St Fintan's Hospital, Portlaoise, Ireland; Kieran C. Murphy, MMedSci PhD FRCPI FRCPsych, Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Fiona Gaughran, MD FRCPI FRCP FRCPsych, National Psychosis Service, South London and Maudsley NHS Foundation Trust, IoPPN, Kings College London, and Collaboration for Leadership in Applied Health Research and Care, South London Psychosis Research Team, London, UK; Robin M. Murray, MD DSc FRCP FRCPsych FMedSci FRS, IoPPN, King's College London, and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
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11
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Downs JM, Lechler S, Dean H, Sears N, Patel R, Shetty H, Simonoff E, Hotopf M, Ford TJ, Diaz-Caneja CM, Arango C, MacCabe JH, Hayes RD, Pina-Camacho L. The Association Between Comorbid Autism Spectrum Disorders and Antipsychotic Treatment Failure in Early-Onset Psychosis: A Historical Cohort Study Using Electronic Health Records. J Clin Psychiatry 2017; 78:e1233-e1241. [PMID: 29125721 PMCID: PMC6037287 DOI: 10.4088/jcp.16m11422] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/12/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE In a sample of children and adolescents with first-episode psychosis, we investigated whether multiple treatment failure (MTF, defined as the initiation of a third trial of novel antipsychotic due to nonadherence, adverse effects, or insufficient response) was associated with comorbid autism spectrum disorders. METHODS Data were from the electronic health records of 638 children (51% male) aged from 10 to 17 years with first-episode psychosis (per ICD-10 criteria) from January 1, 2008, to November 1, 2014, referred to mental health services in South London, United Kingdom; data were extracted using the Clinical Record Interactive Search (CRIS) system. The effect of autism spectrum disorder comorbidity on the development of MTF during a 5-year period was modeled using Cox regression. RESULTS There were 124 cases of MTF prior to the age of 18 (19.4% of the sample). Comorbid autism spectrum disorders were significantly associated with MTF (adjusted hazard ratio = 1.99; 95% CI, 1.19-3.31; P = .008) after controlling for a range of potential confounders. Other factors significantly associated with MTF included higher age at first presentation (P = .001), black ethnicity (P = .03), and frequency of clinical contact (P < .001). No significant association between other comorbid neurodevelopmental disorders (hyperkinetic disorder or intellectual disability) and MTF was found. CONCLUSIONS Children with first-episode psychosis and comorbid autism spectrum disorders at first presentation are less likely to have a beneficial response to antipsychotics.
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Affiliation(s)
- Johnny M. Downs
- Institute of Psychiatry, Psychology Neuroscience, King’s College London, UK,NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, UK
| | - Suzannah Lechler
- Institute of Psychiatry, Psychology Neuroscience, King’s College London, UK,NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, UK
| | - Harry Dean
- Institute of Psychiatry, Psychology Neuroscience, King’s College London, UK,NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, UK
| | - Nicola Sears
- Institute of Psychiatry, Psychology Neuroscience, King’s College London, UK,NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, UK
| | - Rashmi Patel
- Institute of Psychiatry, Psychology Neuroscience, King’s College London, UK,NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, UK
| | - Hitesh Shetty
- NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, UK
| | - Emily Simonoff
- Institute of Psychiatry, Psychology Neuroscience, King’s College London, UK,NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology Neuroscience, King’s College London, UK,NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, UK
| | | | - Covadonga M. Diaz-Caneja
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | - James H. MacCabe
- Institute of Psychiatry, Psychology Neuroscience, King’s College London, UK,NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, UK
| | - Richard D. Hayes
- Institute of Psychiatry, Psychology Neuroscience, King’s College London, UK,NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, UK
| | - Laura Pina-Camacho
- Institute of Psychiatry, Psychology Neuroscience, King’s College London, UK,NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, UK,Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
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12
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Paruk S, Jhazbhay K, Singh K, Sartorius B, Burns JK. Clinical correlates of first episode early onset psychosis in KwaZulu-Natal, South Africa. J Child Adolesc Ment Health 2016; 27:103-11. [PMID: 26357916 DOI: 10.2989/17280583.2015.1080710] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The study of first episode early onset psychosis can yield many clues to understanding the early development of psychosis and guide interventions to decrease psychosis risk and improve outcome. The aim of the study was to investigate the socio-demographic profile and clinical correlates in early onset psychosis. METHOD Forty-five adolescents with first episode early onset psychosis were assessed by a clinical interview, socio-demographic questionnaire, the Positive and Negative Syndrome Scale (PANSS), Symptom Onset in Schizophrenia (SOS) score, the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST) questionnaire for substance misuse and a urine cannabis level. RESULTS The mean age of the respondents was 15.9 years (SD 1.8, range 10-18 years). Thirty-one (69%) were male. There was a poor recognition of the prodromal period in 22 (49%) patients and caregivers. The mean duration of untreated psychosis (DUP) was 27.2 weeks (SD 56.7). There was a negative correlation between DUP and age of onset (p<0.05). Mean age at onset of psychosis (males 15.7 years, SD 2.2, and females 15.3 years, SD 2.6) and mean age of presentation (males 16.0 years, SD 1.8, and females 15.5 years, SD 1.7) was slightly younger in the females than males, but not statistically significant. A total of 25 (56%) adolescents reported lifetime cannabis use and 24 (96%) were male. CONCLUSION Symptoms of the prodromal period were poorly recognised. The mean DUP suggests a significant delay in treatment and younger children had a longer DUP. The gender differences in presentation (marginal) and substance use (highly significant) suggests that there may be different environmental risk factors for males and females in early onset psychosis or that early onset psychosis is more genetically homogenous and less dependent on environmental triggers.
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Affiliation(s)
- Saeeda Paruk
- a Department of Psychiatry, Nelson R Mandela School of Medicine , University of KwaZulu-Natal
| | - Khadija Jhazbhay
- a Department of Psychiatry, Nelson R Mandela School of Medicine , University of KwaZulu-Natal
| | - Keshika Singh
- a Department of Psychiatry, Nelson R Mandela School of Medicine , University of KwaZulu-Natal
| | - Benn Sartorius
- b Department of Public Health Medicine, School of Nursing and Public Health , University of KwaZulu-Natal
| | - Jonathan K Burns
- a Department of Psychiatry, Nelson R Mandela School of Medicine , University of KwaZulu-Natal
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13
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Stentebjerg-Olesen M, Pagsberg AK, Fink-Jensen A, Correll CU, Jeppesen P. Clinical Characteristics and Predictors of Outcome of Schizophrenia-Spectrum Psychosis in Children and Adolescents: A Systematic Review. J Child Adolesc Psychopharmacol 2016; 26:410-27. [PMID: 27136403 DOI: 10.1089/cap.2015.0097] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Treatment of early-onset schizophrenia spectrum psychosis (EOS) is hampered by limited data on clinical presentation and illness course. We aimed to systematically review the clinical characteristics, diagnostic trajectories, and predictors of illness severity and outcomes of EOS. METHODS We conducted a systematic PubMed, PsycINFO, and Embase literature review including studies published from January 1, 1990 to August 8, 2014 of EOS patients with 1) ≥50% nonaffective psychosis cases; 2) mean age of subjects <19 years; 3) clinical samples recruited through mental health services; 4) cross-sectional or prospective design; 5) ≥20 participants at baseline; 6) standardized/validated diagnostic instruments; and 7) quantitative psychotic symptom frequency or severity data. Exploratory analyses assessed associations among relevant clinical variables. RESULTS Across 35 studies covering 28 independent samples (n = 1506, age = 15.6 years, age at illness onset = 14.5 years, males = 62.3%, schizophrenia-spectrum disorders = 89.0%), the most frequent psychotic symptoms were auditory hallucinations (81.9%), delusions (77.5%; mainly persecutory [48.5%], referential [35.1%], and grandiose [25.5%]), thought disorder (65.5%), bizarre/disorganized behavior (52.8%), and flat or blunted affect/negative symptoms (52.3%/50.4%). Mean baseline Positive and Negative Syndrome Scale (PANSS)-total, positive, and negative symptom scores were 84.5 ± 10.9, 19.3 ± 4.4 and 20.8 ± 2.9. Mean baseline Clinical Global Impressions-Severity and Children's Global Assessment Scale/Global Assessment of Functioning (CGAS/GAF) scores were 5.0 ± 0.7 and 35.5 ± 9.1. Comorbidity was frequent, particularly posttraumatic stress disorder (34.3%), attention-deficit/hyperactivity and/or disruptive behavior disorders (33.5%), and substance abuse/dependence (32.0%). Longer duration of untreated psychosis (DUP) predicted less CGAS/GAF improvement (p < 0.0001), and poor premorbid adjustment and a diagnosis of schizophrenia predicted less PANSS negative symptom improvement (p = 0.0048) at follow-up. Five studies directly comparing early-onset with adult-onset psychosis found longer DUP in EOP samples (18.7 ± 6.2 vs. 5.4 ± 3.1 months, p = 0.0027). CONCLUSIONS EOS patients suffer substantial impairment from significant levels of positive and negative symptoms. Although symptoms and functioning improve significantly over time, pre-/and comorbid conditions are frequent, and longer DUP and poorer premorbid adjustment is associated with poorer illness outcome.
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Affiliation(s)
- Marie Stentebjerg-Olesen
- 1 Child and Adolescent Mental Health Center , Mental Health Services, the Capital Region of Denmark, Copenhagen, Denmark .,2 Faculty of Health Science, University of Copenhagen , Copenhagen, Denmark
| | - Anne K Pagsberg
- 1 Child and Adolescent Mental Health Center , Mental Health Services, the Capital Region of Denmark, Copenhagen, Denmark .,2 Faculty of Health Science, University of Copenhagen , Copenhagen, Denmark
| | - Anders Fink-Jensen
- 3 Mental Health Center, Copenhagen University Hospital , Copenhagen, Denmark .,4 Laboratory of Neuropsychiatry, Department of Neuroscience and Pharmacology, University of Copenhagen , Copenhagen, Denmark
| | - Christoph U Correll
- 5 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish Health System, Glen Oaks, New York.,6 Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine , Hempstead, New York.,7 The Feinstein Institute for Medical Research , Manhasset, New York.,8 Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine , Bronx, New York
| | - Pia Jeppesen
- 1 Child and Adolescent Mental Health Center , Mental Health Services, the Capital Region of Denmark, Copenhagen, Denmark .,2 Faculty of Health Science, University of Copenhagen , Copenhagen, Denmark
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14
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Lo TL, Warden M, He Y, Si T, Kalyanasundaram S, Thirunavukarasu M, Amir N, Hatim A, Bautista T, Lee C, Emsley R, Olivares J, Yang YK, Kongsakon R, Castle D. Recommendations for the optimal care of patients with recent-onset psychosis in the Asia-Pacific region. Asia Pac Psychiatry 2016; 8:154-71. [PMID: 27062665 PMCID: PMC4834614 DOI: 10.1111/appy.12234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 12/29/2015] [Indexed: 12/31/2022]
Abstract
Providing optimal care to patients with recent-onset psychosis can improve outcomes and reduce relapse. However, there is a lack of consistency of the implementation of guidelines for such patients across the Asia-Pacific region. We determined a pragmatic set of recommendations for use on a day-to-day basis to help provide optimal care at this crucial stage of illness. The recommendations were developed over a series of meetings by an international faculty of 15 experts from the Asia-Pacific region, Europe, and South Africa. A structured search of the PubMed database was conducted. This was further developed based on the faculty's clinical experience and knowledge of the literature into 10 key aspects of optimal care for patients during the first five years of a diagnosis of a psychotic disorder, with particular relevance to the Asia-Pacific region. Several common principles emerged: adherence to antipsychotic medications is crucial; substance abuse, psychiatric and medical comorbidities should be addressed; psychosocial interventions play a pivotal role; and family members can play a vital role in overall patient care. By following these recommendations, clinicians may improve outcomes for patients with recent-onset psychosis.
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Affiliation(s)
| | - Matthew Warden
- Hobart and Southern CMHTTasmanian Health Organisation – SouthTasmaniaAustralia
| | - Yanling He
- Department of Epidemiology Shanghai Mental Health CenterShanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Tianmei Si
- Department of PsychopharmacologyPeking University Institute of Mental HealthPekingChina
| | | | | | - Nurmiati Amir
- Department of Psychiatry National General HospitalCiptomangunkusumo/Faculty of MedicineUniversity of IndonesiaJakartaIndonesia
| | - Ahmad Hatim
- Department of Psychological MedicineUniversity of MalayaKuala LumpurMalaya
| | - Tomas Bautista
- College of Medicine Philippine General HospitalUniversity of the PhilippinesManilaPhilippines
| | - Cheng Lee
- Department of Community PsychiatryInstitute of Mental HealthSingapore
| | - Robin Emsley
- Department of PsychiatryUniversity of StellenboschStellenboschSouth Africa
| | - Jose Olivares
- Department of PsychiatryComplejo Hospitalario Universitario de VigoVigoSpain
| | - Yen Kuang Yang
- Department of PsychiatryNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainan CityTaiwan
| | | | - David Castle
- Department of PsychiatrySt. Vincent's HospitalThe University of MelbourneMelbourneAustralia
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15
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Vernal DL, Kapoor S, Al-Jadiri A, Sheridan EM, Borenstein Y, Mormando C, David L, Singh S, Seidman AJ, Carbon M, Gerstenberg M, Saito E, Kane JM, Steinhausen HC, Correll CU. 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. J Child Adolesc Psychopharmacol 2015; 25:535-47. [PMID: 26375767 PMCID: PMC4696429 DOI: 10.1089/cap.2014.0164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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.
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Affiliation(s)
- Ditte L. Vernal
- Research Unit for Child and Adolescent Psychiatry, Psychiatric Hospital, Aalborg University Hospital, Denmark.,The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Sandeep Kapoor
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Aseel Al-Jadiri
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Eva M. Sheridan
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Yehonathan Borenstein
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Charles Mormando
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Lisa David
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Sukhbir Singh
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Andrew J. Seidman
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Maren Carbon
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Miriam Gerstenberg
- University Clinics of Child and Adolescent Psychiatry, University of Zurich, Switzerland
| | - Ema Saito
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - John M. Kane
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York.,Hofstra North Shore-LIJ School of Medicine, Hempstead, New York.,Albert Einstein College of Medicine, Bronx, New York.,The Feinstein Institute for Medical Research, Manhasset, New York
| | - Hans-Christoph Steinhausen
- Research Unit for Child and Adolescent Psychiatry, Psychiatric Hospital, Aalborg University Hospital, Denmark.,Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Switzerland.,Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland
| | - Christoph U. Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York.,Hofstra North Shore-LIJ School of Medicine, Hempstead, New York.,Albert Einstein College of Medicine, Bronx, New York.,The Feinstein Institute for Medical Research, Manhasset, New York
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Psychosocial interventions for very early and early-onset schizophrenia: a review of treatment efficacy. Curr Opin Psychiatry 2015; 28:312-23. [PMID: 26001923 DOI: 10.1097/yco.0000000000000165] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Very early (VEOS) and early-onset schizophrenia (EOS) represent more severe forms of the disorder, with clear differences from adult-onset schizophrenia (AOS). However, there is a distinct lack of evidence regarding the efficacy of psychosocial interventions in this group of patients, and to date no systematic review has been conducted on the topic. The aim of this article is to review the current knowledge and evidence on the efficacy of psychosocial interventions in VEOS/EOS. RECENT FINDINGS A total of eight articles were eligible for inclusion. Four studies evaluated psychoeducational and family interventions for patients with VEOS/EOS, whereas four studies focused on cognitive behavioral therapy or cognitive remediation. Overall, we found some preliminary evidence for the efficacy of psychosocial interventions in the treatment of VEOS/EOS. This evidence was strongest for cognitive remediation. SUMMARY Heretofore, VEOS/EOS have been treated primarily with psychosocial interventions based on evidence from interventions tailored for and tested on adults. Although more conclusive studies are still needed, thanks to recent clinical trials, we now have greater evidence to support the efficacy of psychosocial interventions in EOS/VEOS.
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Psychological Predictors of Vocational Success for People with Psychotic Illness. AUSTRALIAN JOURNAL OF REHABILITATION COUNSELLING 2015. [DOI: 10.1017/jrc.2015.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
People diagnosed with psychotic illness continue to be underrepresented in the workforce despite the widespread provision of vocational rehabilitation services for people experiencing mental illness. A systematic literature review was undertaken using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to identify psychological predictors of successful return to work for this population. The databases searched were PsycARTICLES, PsycINFO, PubMed, ProQuest, Cumulative Index of Nursing and Allied Health (CINAHL), and Taylor & Francis Online. A total of 4,076 articles were located and of these, 29 articles were analysed as part of this review. The data extracted was synthesised using a narrative approach. A number of psychological factors were identified which are predictive of successful return to work. These factors include but are not limited to identity, self-management of illness, social cognition, hope and self-esteem and motivation. On the basis of the reviewed literature, practice guidelines are proposed which support the psychological processes identified as pivotal to vocational success for people diagnosed with psychotic illness.
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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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Remberk B, Bażyńska AK, Bronowska Z, Potocki P, Krempa-Kowalewska A, Niwiński P, Rybakowski F. Which aspects of long-term outcome are predicted by positive and negative symptoms in early-onset psychosis? An exploratory eight-year follow-up study. Psychopathology 2015; 48:47-55. [PMID: 25471137 DOI: 10.1159/000366489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 08/06/2014] [Indexed: 11/19/2022]
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.
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Affiliation(s)
- Barbara Remberk
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
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Remberk B, Bażyńska AK, Krempa-Kowalewska A, Rybakowski F. Adolescent insanity revisited: course and outcome in early-onset schizophrenia spectrum psychoses in an 8-year follow-up study. Compr Psychiatry 2014; 55:1174-81. [PMID: 24794640 DOI: 10.1016/j.comppsych.2014.03.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/22/2014] [Accepted: 03/25/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Despite inclusion of adolescent insanity-a concept proposed by Thomas Clouston in late XIX century-into the broader nosological entity of dementia praecox, the uniqueness of early psychosis is still discussed. The aim of the current study is the assessment of course and outcome in the large sample of early-onset psychosis subjects. METHOD Of 299 patients hospitalized in the period 1998-2008 in an adolescent psychiatry ward with schizophrenia spectrum diagnosis 158 completed a follow-up interview. Data concerning current diagnosis, further admissions, current treatment status and occupational and relationship outcome were analyzed after a mean of 8 years of follow-up. RESULTS Mean age at the index admission and the follow-up was 16.6 ± 1.2 and 24.5 ± 3.0 years respectively. After the subsequent discharge almost all subjects (97%) at least briefly continued psychiatric treatment and 75% of patients had been readmitted. Overall diagnostic stability was 42%. For schizophrenia spectrum disorders and schizophrenia diagnostic stability was 72% and 78%, respectively. At the follow-up assessment 119 (77.3%) of the traced subjects declared current psychiatric treatment and 110 (73.3%) were receiving pharmacotherapy. Almost half of the subjects (48%) were employed or studying and more than a third (35.8%) remained in a stable relationship. Different distributions of baseline diagnoses were observed in males and females, and the latter showed a better outcome. CONCLUSION Early-onset psychoses were characterized by limited diagnostic stability, a necessity for further treatment and hospitalizations and significant percentage of unfavorable functional outcomes. Baseline diagnosis of acute and transient psychotic disorders and female gender were associated with an overall better outcome.
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Affiliation(s)
- Barbara Remberk
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology, ul. Sobieskiego 9, 02-957 Warsaw, Poland.
| | - Anna Katarzyna Bażyńska
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology, ul. Sobieskiego 9, 02-957 Warsaw, Poland.
| | | | - Filip Rybakowski
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology, ul. Sobieskiego 9, 02-957 Warsaw, Poland; University of Social Sciences and Humanities, ul. Kutrzeby 10, Poznan, Poland.
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Children with attention deficit-hyperactivity disorder and comorbid depression. MIDDLE EAST CURRENT PSYCHIATRY 2013. [DOI: 10.1097/01.xme.0000430428.98481.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
BACKGROUND The current review analyzes the long-term outcome and prognosis of early onset schizophrenia based on previously published studies in 1980. METHODS A systematic search of articles published in the English-language literature after 1980 identified a total of 21 studies, which included 716 patients who were either suffering from early onset schizophrenia (EOS) or both EOS and other psychotic disorders (MIX). The authors of the current review scored the outcome as either "good," "moderate," or "poor." The mean age of onset in these studies was <18 years. RESULTS In general, the outcome in studies with EOS is worse than the outcome in MIX studies. Only 15.4% of the patients in EOS studies versus 19.6% of the patients in MIX studies experienced a "good" outcome. In contrast, 24.5% of the patients in EOS studies versus 33.6% in MIX studies experienced a "moderate" outcome, and 60.1% in EOS studies versus 46.8% in MIX studies experienced a "poor" outcome. The authors identified various significant effects on outcome. In EOS, the findings were significantly affected by sample attrition, indicating that in studies with a high dropout rate, fewer patients experienced a "moderate" outcome, and more patients experienced a "poor" outcome; however, the effect sizes were small. Furthermore, the effects were also small and more favourable for specific functioning measures, as opposed to more global measures, small to moderate in terms of worse outcomes for follow-up periods >10 years, small to moderate for more unfavourable outcomes in males, and small to large for worse outcomes in studies including patients diagnosed before 1970. CONCLUSIONS In contrast to the adult manifestation, the early manifestation of schizophrenia in childhood and adolescence still carries a particularly poor prognosis. According to these aggregated data analyses, longer follow-up periods, male sex, and patients having been diagnosed before 1970 contribute predominantly to the rather poor course of EOS.
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