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Youth with emerging psychiatric disorders at risk for illness progression

Psychotic-like experiences, circadian disturbances, poorer social function and manic-like experiences were linked to illness progression in a longitudinal cohort study of youth who presented to early intervention services for psychiatric disorders.

“Although 75% of major psychiatric disorders begin before the age of 25 years, current adult-based thresholds for diagnosis often map weakly onto earlier and nonspecific patterns of illness in young people,” Frank Iorfino, PhD, from the youth mental health team at University of Sydney’s Brain and Mind Centre, and colleagues wrote in JAMA Psychiatry. “The challenge is to derive classification systems that are consistent with the neurobiological development of young people and patterns of disease development, and that are clinically useful.”

According to the researchers, clinical staging can help improve diagnosis of emerging psychiatric disorders among young people presenting for care. Therefore, they conducted an observational study of 2,254 youth aged 12 to 25 years who obtained care at early intervention mental health services in Sydney to examine the rates of transition from earlier (subthreshold) to later (full-threshold) clinical stages of anxiety, mood, psychotic or comorbid disorders.

They also reported the demographic (age, sex, engagement in education, employment, or both) and clinical (social function, clinical presentation, history of mental illness, physical health comorbidities, treatment use, self-harm, suicidal thoughts and behaviors) characteristics linked to these transitions. The median follow-up was 14 months.

Of 685 participants with nonspecific symptoms (stage 1a), more than one-third (n = 253) progressed to have attenuated syndromes (stage 1b).

Factors associated with transitioning to stage 1b were: social functioning (HR = 0.77; 95% CI, 0.66-0.9); engagement with education, employment, or both (HR = 0.47; 95% CI, 0.25-0.91), manic-like experiences (HR = 2.12; 95% CI, 1.19-3.78), psychotic-like experiences (HR = 2.13; 95% CI, 1.38-3.28), self-harm (HR = 1.42; 95% CI, 1.01-1.99) and older age (HR = 1.27; 95% CI, 1.11-1.45), according to the results.

Of 1,370 participants initially classified at stage 1b, more than 10% (n = 176) progressed to full-threshold disorders (stage 2).

Iorfino and colleagues found that factors associated with transitioning were: psychotic-like experiences (HR = 2.31; 95% CI, 1.65-3.23), circadian disturbance (HR = 1.66; 95% CI, 1.17-2.35), psychiatric medication use (HR = 1.43; 95% CI, 1.03-1.99), childhood history of psychiatric disorder (HR = 1.62; 95% CI, 1.03-2.54) and older age (HR = 1.24; 95% CI, 1.05-1.45).

In addition, the results showed that 24.2% of participants who transitioned to stage 2 mainly had a psychotic-type syndrome, 44.3% had a bipolar syndrome and 31.4% had a major anxiety or depressive syndrome.

“These findings ... provide the basis for the implementation of the clinical staging model in daily practice with young people; the design of specific youth clinical service models to support the efficient allocation of appropriate care; and the evidence-based planning of stage-based early intervention and secondary prevention studies,” the researchers wrote. – by Savannah Demko

Disclosure: Iorfino reports nor relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.