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Comorbidities may mask early-onset psychosis, increasing risk for untreated illness

Comorbidity was common in early-onset psychosis and may explain higher risk for longer duration of untreated illness, according to recent findings.

“An increased evidence base concerning the clinical presentation and course of psychosis in childhood and adolescence is the first step toward identifying improved strategies for early detection and development of more operational treatment guidelines,” Marie Stentebjerg-Olesen, MD, of University of Copenhagen, Denmark, and colleagues wrote. “Currently, the commonly cited facts are based on a small number of studies of limited quality because of small sample sizes, retrospectively defined samples, lack of standardized assessments for diagnostic evaluation, and the mixing of data from first and multi-episode patients.”

To assess clinical characteristics, diagnostic trajectories and predictors of severity and outcomes of early-onset schizophrenia, researchers conducted a systematic literature review of 35 studies published from January 1990 to August 2014. Analysis included 1,506 individuals with early-onset schizophrenia, a mean age of 15.6 years, and a mean age at illness onset of 14.5 years.

The most frequent psychotic symptoms were auditory hallucinations (81.9%), delusions (77.5%), bizarre/disorganized behavior (52.8%), and flat or blunted affect (52.3%) and negative symptoms (50.4%).

Study participants had mean baseline Positive and Negative Syndrome Scale (PANSS) scores of 84.5 for total symptoms, 19.3 for positive symptoms and 20.8 for negative symptoms.

Participants had a mean Clinical Global Impressions-Severity score of 5 and mean Children’s Global Assessment Scale/Global Assessment of Functioning score of 35.5 at baseline.

Comorbidity was common, particularly PTSD (34.3%), attention-deficit/hyperactivity and/or disruptive behavior disorders (33.5%) and substance abuse or dependence (32%).

Longer duration of untreated psychosis predicted lower improvement in Children’s Global Assessment Scale/Global Assessment of Functioning scores (P < .0001).

Poor premorbid adjustment and a diagnosis of schizophrenia predicted lower improvement in PANSS negative symptom scores at follow-up (P = .0048).

Five studies that compared early-onset with adult-onset psychosis indicated longer duration of untreated psychosis among those with early-onset illness (18.7 vs. 5.4 months; P = .0027).

“The high prevalence of negative and disorganized symptomatology in [early-onset schizophrenia spectrum psychosis] patients in the context of co-occurring nonpsychotic mental disorders may mask the emergence of psychosis and thereby explain the higher risk of delayed identification and treatment of [early-onset schizophrenia spectrum psychosis]. These findings emphasize the need for early detection and treatment of psychosis in youth. The comorbid conditions of ADHD/disruptive behavior disorders, substance abuse, and PTSD are treatable conditions, which may be helpful to target, especially in youth with signs of emerging psychosis,” the researchers concluded. – by Amanda Oldt

Disclosure: Stentebjerg-Olesen reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.