The Clinical Presentation of Early-Onset Psychotic Disorders: A Descriptive Study in Child and Adolescent Inpatient Setting
Abstract
Background: Early-onset psychosis starts before the age of 18 years. It differs from the adult-onset psychosis in terms of the clinical presentation and response to the therapy. The aim of the study was to identify the common symptoms of Early Onset Psychosis and the social and educational impairment resulting from it.
Methods: A retrospective study was conducted in Child and Adolescent Psychiatry Department, Mayo Hospital, Lahore to assess the clinical profile of patients diagnosed with psychotic disorders.. A proforma was designed for data extraction based on the literature review and in accordance with DSM-5 which included common presenting symptoms at admission along with other relevant clinical and demographic information. Data was collected from the inpatient file records
Results: A total of 116 inpatient record files of admitted patients were included. 70% of the patients were females and the mean age at admission was 13(±1.6). Schizophrenia spectrum disorders were present in 78% of the patients and Brief Psychotic Disorder was the most common diagnosis. Symptoms including odd behavior, speech disorganization, deterioration in daily life activities, and perceptual abnormalities were the most common symptoms.
Conclusion: The study provides insight into the clinical presentation and psychosocial impact of psychosis in children and adolescents. It can help in the early detection of Psychotic Disorders in this age group and in formulating a better treatment and management plan.
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References
2. Kao YC, Liu YP. Effects of age of onset on clinical characteristics in schizophrenia spectrum disorders. BMC Psychiatry. 2010 Aug 18;10:63. doi:10.1186/1471-244X-10-63.
3. Biswas P, Malhotra S, Malhotra A, Gupta N. Comparative study of neurological soft signs in schizophrenia with onset in childhood, adolescence, and adulthood. Acta Psychiatr Scand. 2007 Apr;115(4):295–303. doi:10.1111/j.1600-0447.2006.00901.x.
4. Lin A, Wardenaar KJ, Pontillo M, De Crescenzo F, Mazzone L, Vicari S, et al. Is it still correct to differentiate between early and very early onset psychosis? Schizophr Res. 2016 Jan 1;170(1):211–6. doi:10.1186/s12888-020-2484-x.
5. Schimmelmann BG, Conus P, Cotton S, McGorry PD, Lambert M. Pre-treatment, baseline, and outcome differences between early-onset and adult-onset psychosis in an epidemiological cohort of 636 first-episode patients. Schizophr Res. 2007 Sep;95(1–3):1–8. doi:10.1016/j.schres.2007.06.004.
6. McClellan J, Stock S, American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry. 2013 Sep;52(9):976–90. doi:10.1016/j.jaac.2013.02.008.
7. Heckers S, Barch DM, Bustillo J, Gaebel W, Gur R, Malaspina D, et al. Structure of the psychotic disorders classification in DSM-5. Schizophr Res. 2013 Oct;150(1):11–4. doi:10.1016/j.schres.2013.04.039.
8. Hafner H, Hambrecht M, Löffler W, Munk-Jørgensen P, Riecher-Rössler A. Is schizophrenia a disorder of all ages? A comparison of first episodes and early course across the life-cycle. Psychol Med [Internet]. 1998 Mar [cited 2022 Nov 19];28(2):351–65. Available from: doi:10.1017/S0033291797006399.
9. Pencer A, Addington J, Addington D. Outcome of a first episode of psychosis in adolescence: a 2-year follow-up. Psychiatry Res. 2005 Jan 30;133(1):35–43. doi:10.1016/j.psychres.2004.10.004.
10. Seidman LJ, Giuliano AJ, Meyer EC, Addington J, Cadenhead KS, Cannon TD, et al. Neuropsychology of the prodrome to psychosis in the NAPLS consortium: relationship to family history and conversion to psychosis. Arch Gen Psychiatry. 2010 Jun 1;67(6):578–88. doi:10.1001/archgenpsychiatry.2010.66.
11. Häfner H. From onset and prodromal stage to a life-long course of schizophrenia and its symptom dimensions: How sex, age, and other risk factors influence incidence and course of illness. Psychiatry J. 2019 Apr 16;2019:1–14. doi:10.1155/2019/9804836.
12. Riecher-Rössler A. Oestrogens, prolactin, hypothalamic-pituitary-gonadal axis, and schizophrenic psychoses. Lancet Psychiatry. 2017 Jan;4(1):63–72. doi:10.1016/S2215-0366(16)30379-5.
13. Paruk S, Jhazbhay K, Singh K, Sartorius B, Burns JK. A comparative study of socio-demographic and substance use correlates in early-onset psychosis. Early Interv Psychiatry. 2018 Jun;12(3):339–47. doi:10.1111/eip.12330.
14. Schothorst PF, Emck C, Van Engeland H. Characteristics of early psychosis. Compr Psychiatry. 2006 Nov 1;47(6):438–42. doi:10.1016/j.comppsych.2006.03.003.
15. Muris P, Meesters C, van den Berg F. The strengths and difficulties questionnaire (SDQ). Eur Child Adolesc Psychiatry. 2003 Feb;12(1):1–8. doi:10.1007/s00787-003-0298-2.
16. Haro JM, Kamath SA, Ochoa SO, Novick D, Rele K, Fargas A, et al. The Clinical Global Impression–Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia. Acta Psychiatr Scand. 2003 May;107(S416):16–23. doi:10.1034/j.1600-0447.107.s416.5.x.
17. Fraguas D, del Rey-Mejías Á, Moreno C, Castro-Fornieles J, Graell M, Otero S, et al. Duration of untreated psychosis predicts functional and clinical outcome in children and adolescents with first-episode psychosis: a 2-year longitudinal study. Schizophr Res. 2014 Jan 1;152(1):130–8. doi:10.1016/j.schres.2013.11.018.
18. Starling J, Williams LM, Hainsworth C, Harris AW. The presentation of early-onset psychotic disorders. Aust N Z J Psychiatry. 2013 Jan;47(1):43–50. doi:10.1177/0004867412463615.
19. González-Pinto A, de Azúa SR, Ibáñez B, Otero-Cuesta S, Castro-Fornieles J, Graell-Berna M, et al. Can positive family factors be protective against the development of psychosis? Psychiatry Res. 2011 Mar 30;186(1):28–33. doi:10.1016/j.psychres.2010.05.015.
20. Meyer SE, Bearden CE, Lux SR, Gordon JL, Johnson JK, O'Brien MP, et al. The psychosis prodrome in adolescent patients viewed through the lens of DSM-IV. J Child Adolesc Psychopharmacol. 2005 Jun 1;15(3):434–51. doi:10.1089/cap.2005.15.434.
21. McClellan JO, Breiger D, McCurry C, Hlastala SA. Premorbid functioning in early-onset psychotic disorders. J Am Acad Child Adolesc Psychiatry. 2003 Jun 1;42(6):666–72. doi:10.1097/01.CHI.0000046844.56865.6B.
22. Trotta A, Di Forti M, Green P, Dazzan P, Mondelli V, Morgan C, et al. Familial risk and childhood adversity interplay in the onset of psychosis. BJPsych Open. 2015 Jun;1(1):6–13. doi:10.1192/bjpo.bp.115.000158.
23. Georgopoulos G, Stowkowy J, Liu L, Cadenhead KS, Cannon TD, Cornblatt BA, et al. The role of a family history of psychosis for youth at clinical high risk of psychosis. Early Interv Psychiatry. 2019 Apr;13(2):251–6.
24. Taylor JH, Huque ZM. Commentary: Schizophrenia prevention and prodromal psychosis in children and adolescents. J Child Psychol Psychiatry. 2021 May;62(5):674–6. doi:10.1111/jcpp.13408.
25. Kaur T, Cadenhead KS. Treatment implications of the schizophrenia prodrome. Behav Neurobiol Schizophr Treat. 2010:97–121. doi:10.1007/7854_2010_56.
26. Cornblatt BA, Auther AM. Treating early psychosis: who, what, and when? Dialogues Clin Neurosci. 2022 Apr 1.
27. Volkmar F. Childhood and adolescent psychosis: A review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 1996;35(7):843–51. doi:10.1097/00004583-199607000-00009.
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