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The Maudsley early onset schizophrenia study

Predictors of psychosocial outcome at 4-year follow-up

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Abstract

Objective

To examine the contribution of premorbid function, duration of untreated psychosis (DUP), age of onset, severity of symptoms at presentation, and number of subsequent hospitalisations to the outcome of early onset schizophrenia (EOS; onset before 17th birthday).

Method

Twenty-three EOS patients (mean age at onset 15.16 ± 1.39 years) were re-assessed after a mean interval of 4 ± 1.08 years. At baseline and follow-up clinical diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Axis I Disorders and symptoms were assessed with the Positive and Negative Syndrome Scale. Premorbid function, as measured with the Premorbid Adjustment Scale, age of onset and DUP were assessed at baseline only. Outcome was evaluated using the Social Adaptation Self-Evaluation Scale (SASS) and the Global Assessment of Functioning (GAF) Scale.

Results

Mean DUP was 2.95 ± 3.59 months and mean total PAS score was 6.65 ± 3.02. They had an average of 2.09 ± 1.44 hospitalisations and their mean SASS and GAF scores were 37.27 ± 6.5 and 54.19 ± 18.99, respectively. Poor childhood premorbid function and the severity of negative symptoms at baseline were correlated with worse SASS and GAF scores. No other significant associations were found.

Conclusions

Poor childhood function is the most significant predictor of outcome in EOS.

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References

  1. Addington J, Addington D (2005) Patterns of premorbid functioning in first episode psychosis: relationship to 2-year outcome. Acta Psychiatr Scand 112:40–46

    Article  PubMed  CAS  Google Scholar 

  2. Altamura AC, Bassetti R, Sassella F, Salvadori D, Mundo E (2001) Duration of untreated psychosis as a predictor of outcome in first-episode schizophrenia: a retrospective study. Schizophr Res 52:29–36

    Article  PubMed  CAS  Google Scholar 

  3. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders (DSM-IV), 4th edn. American Psychiatric Association Press, Washington, DC

    Google Scholar 

  4. Andreasen NC, Carpenter WT Jr, Kane JM, Lasser RA, Marder SR, Weinberger DR (2005) Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry 162(3):441–449

    Article  PubMed  Google Scholar 

  5. Asarnow JR, Tompson MC, Goldstein MJ (1994) Childhood-onset schizophrenia: a follow-up study. Schizophr Bull 20:599–617

    PubMed  CAS  Google Scholar 

  6. Barnes TRE, Hutton SB, Chapman MJ, Mutsatsa S, Puri BK, Joyce EM (2000) West London first-episode study of schizophrenia. Clinical correlates of duration of untreated psychosis. Br J Psychiatry 177:207–211

    Article  PubMed  CAS  Google Scholar 

  7. Black K, Peters L, Rui Q, Milliken H, Whitehorn D, Kopala LC (2001) Duration of untreated psychosis predicts treatment outcome in an early psychosis program. Schizophr Res 47:215–222

    Article  PubMed  CAS  Google Scholar 

  8. Bosc M, Dubini A, Polin V (1997) Development and validation of a social functioning scale, the Social Adaptation Self-evaluation Scale. Eur Neuropsychopharmacol 7(Suppl 1):S57–S70

    Article  PubMed  CAS  Google Scholar 

  9. Browne S, Clarke M, Gervin M, Waddington JL, Larkin C, O’Callaghan E (2000) Determinants of quality of life at first presentation with schizophrenia. Br J Psychiatry 176:173–176

    Article  PubMed  CAS  Google Scholar 

  10. Cannon-Spoor HE, Potkin SG, Wyatt KJ (1982) Measurement of premorbid adjustment in chronic schizophrenia. Schizophr Bull 8:470–484

    PubMed  CAS  Google Scholar 

  11. Craig TJ, Bromet EJ, Fennig S, Tanenberg-Karant M, Lavelle J, Galambos N (2000) Is there an association between duration of untreated psychosis and 24-month clinical outcome in a first-admission series? Am J Psychiatry 157:60–66

    PubMed  CAS  Google Scholar 

  12. de Haan L, van der Gaag M, Wolthaus J (2000) Duration of untreated psychosis and the long-term course of schizophrenia. Eur Psychiatry 15:264–267

    Article  PubMed  Google Scholar 

  13. Eggers C, Bunk D (1997) The long-term course of childhood-onset schizophrenia: a 42-year follow up. Schizophr Bull 23:105–117

    PubMed  CAS  Google Scholar 

  14. First MB, Spitzer RL, Gibbon M, Williams JBW (1997) Structured clinical interview for DSM-IV Axis I disorders, research version, patient edition (SCID-I/P) Biometrics research. New York State Psychiatric Institute, New York

    Google Scholar 

  15. Friis S, Melle I, Larsen TK, Haahr U, Johannessen JO, Simonsen E, Opjordsmoen S, Vaglum P, McGlashan TH (2004) Does duration of untreated psychosis bias study samples of first-episode psychosis? Acta Psychiatr Scand 110:286–291

    Article  PubMed  CAS  Google Scholar 

  16. Gillberg IC, Hellgren L, Gillberg C (1993) Psychotic disorders diagnosed in adolescence. Outcome at age 30 years. J Child Psychol Psychiatry Allied Disciplines 34:1173–1185

    Article  CAS  Google Scholar 

  17. Gupta S, Andreasen N, Arndt S, Flaum M, Hubbard W, Ziebell S (1997) The Iowa longitudinal study of recent onset psychosis: one-year follow-up of first episode patients. Schizophr Res 23:1–13

    Article  PubMed  CAS  Google Scholar 

  18. Haas GL, Garratt LS, Sweeney JA (1998) Delay to first antipsychotic medication in schizophrenia: impact on symptomatology and clinical course of illness. J Psychiatr Res 32:151–159

    Article  PubMed  CAS  Google Scholar 

  19. Hadjulis M, Pipe R, Frangou S (2004) Normal cerebral volume asymmetries in early onset schizophrenia. Biol Psychiatry 55:148–153

    Article  PubMed  Google Scholar 

  20. Häfner H, Nowotny B (1995) Epidemiology of early-onset schizophrenia. Eur Arch Psychiatry Clin Neurosci 245:80–92

    Article  PubMed  Google Scholar 

  21. Ho BC, Andreasen NC, Flaum M, Nopoulos P, Miller D (2000) Untreated initial psychosis: its relation to quality of life and symptom remission in first-episode schizophrenia. Am J Psychiatry 157:808–815

    Article  PubMed  CAS  Google Scholar 

  22. Ho BC, Nopoulos P, Flaum M, Arndt S, Andreasen NC (1998) Two-year outcome in first-episode schizophrenia: predictive value of symptoms for quality of life. Am J Psychiatry 155:1196–1201

    PubMed  CAS  Google Scholar 

  23. Hoff AL, Sakuma M, Razi K, Heydebrand G, Csernansky JG, DeLisi LE (2000) Lack of association between duration of untreated illness and severity of cognitive and structural brain deficits at the first episode of schizophrenia. Am J Psychiatry 157:1824–1828

    Article  PubMed  CAS  Google Scholar 

  24. Hollis C (2000) Adult outcome of child- and adolescent-onset schizophrenia: diagnostic stability and predictive validity. Am J Psychiatry 157:1652–1659

    Article  PubMed  CAS  Google Scholar 

  25. Kay SR, Opler LA, Lindenmayer JP (1989) The Positive and Negative Syndrome Scale (PANSS): rationale and standardisation. Br J Psychiatry 155(Suppl 7):S59–S65

    Google Scholar 

  26. Kravariti E, Morris RG, Rabe-Hesketh S, Murray R, Frangou S (2003a) The Maudsley early onset schizophrenia study: cognitive function in adolescents with recent onset schizophrenia. Schizophr Res 61:137–148

    Article  Google Scholar 

  27. Kravariti E, Morris RG, Rabe-Hesketh S, Murray R, Frangou S (2003b) The Maudsley early onset schizophrenia study: cognitive function in adolescent – onset schizophrenia. Schizophr Res 65:95–103

    Article  Google Scholar 

  28. Lay B, Blanz B, Hartmann M, Schmidt MH (2000) The psychosocial outcome of adolescent onset schizophrenia: a 12-year follow-up. Schizophr Bull 26:801–816

    PubMed  CAS  Google Scholar 

  29. Loebel AD, Lieberman JA, Alvir JM, Mayerhoff DI, Geisler SH, Szymanski SR (1992) Duration of psychosis and outcome in first-episode schizophrenia. Am J Psychiatry 149:1183–1188

    PubMed  CAS  Google Scholar 

  30. Malla AK, Norman RM, Manchanda R, Ahmed MR, Scholten D, Harricharan R, Cortese L, Takhar J (2002) One year outcome in first episode psychosis: influence of DUP and other predictors. Schizophr Res 54:231–242

    Article  PubMed  Google Scholar 

  31. Marshall M, Lockwood A (2004) Early intervention for psychosis. Cochrane Database System Rev 2:CD004718

    Google Scholar 

  32. Matsumoto H, Simmons A, Williams S, Hadjulis M, Pipe R, Murray R, Frangou S (2001a) Superior temporal gyrus abnormalities in early-onset schizophrenia: similarities and differences with adult-onset schizophrenia. Am J Psychiatry 158:1299–1304

    Article  CAS  Google Scholar 

  33. Matsumoto H, Simmons A, Williams S, Pipe R, Murray R, Frangou S (2001b) Structural magnetic imaging of the hippocampus in early onset schizophrenia. Biol Psychiatry 49:824–831

    Article  CAS  Google Scholar 

  34. Matzner F, Silva R, Silvan M, Chowdhury M, Nastasi L (1997) Preliminary test–retest reliability of the KID-SCID. In: 42nd annual meeting of the American academy of child and adolescent psychiatry, New Orleans, USA

  35. Maziade M, Bouchard S, Gingras N, Charron L, Cardinal A, Roy M-A, Gauthier B, Tremblay G, Cote S, Fournier C, Boutin P, Hamel M, Merette C, Martinez M (1996) Long term stability of diagnosis and symptom dimensions in a systematic sample of patients with onset of schizophrenia in childhood and early adolescence. II: positive/negative distinction and childhood predictors of adult outcome. Br J Psychiatry 169:371–378

    Article  PubMed  CAS  Google Scholar 

  36. McClellan J, Breiger D, McCurry C, Hlastala SA (2003) Premorbid functioning in early-onset psychotic disorders. J Am Acad Child Adolesc Psychiatry 42:666–672

    Article  PubMed  Google Scholar 

  37. Nicolson R, Lenane M, Singaracharlu S, Malaspina D, Giedd JN, Hamburger SD, Gochman P, Bedwell J, Thakar GK, Fernandez T, Wudarsky M, Hommer DW, Rapoport JL (2000) Premorbid speech and language impairments in childhood – onset schizophrenia: association with risk factors. Am J Psychiatry 157:794–800

    Article  PubMed  CAS  Google Scholar 

  38. Norman RMG, Townsend L, Malla AK (2001) Duration of untreated psychosis and cognitive functioning in first-episode patients. Br J Psychiatry 179:340–345

    Article  PubMed  CAS  Google Scholar 

  39. Robinson DG, Woerner MG, McMeniman M, Mendelowitz A, Bilder RM (2004) Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder. Am J Psychiatry 161:473–479

    Article  PubMed  Google Scholar 

  40. Vourdas A, Pipe R, Corrigal R, Frangou S (2003) Increased developmental deviance and premorbid dysfunction in early onset schizophrenia. Schizophr Res 62:13–22

    Article  PubMed  Google Scholar 

  41. Werry JS, McClellan JM, Andrews LK, Ham M (1994) Clinical features and outcome of child and adolescent schizophrenia. Schizophr Bull 20:619–630

    PubMed  CAS  Google Scholar 

  42. WHOQOL Group (1995) The World Health Organization Quality of Life Assessment (the WHOQOL): position paper from the World Health Organisation. Soc Sci Med 41:1403–1409

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by a research grant from the Stanley Medical Research Institute to Dr S. Frangou.

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Authors and Affiliations

  1. Section of Neurobiology of Psychosis, Institute of Psychiatry, PO66 De Crespigny Park, London, SE5 8AF, UK

    Nora S. Vyas BSc, Michael Hadjulis MD, Apostolos Vourdas MD, PhD & Sophia Frangou MD, PhD

  2. Adolescent Unit, South London and Maudsley NHS Trust, London, UK

    Patrick Byrne MD

Authors
  1. Nora S. Vyas BSc
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  2. Michael Hadjulis MD
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  3. Apostolos Vourdas MD, PhD
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  4. Patrick Byrne MD
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  5. Sophia Frangou MD, PhD
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Corresponding author

Correspondence to Sophia Frangou MD, PhD.

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Vyas, N.S., Hadjulis, M., Vourdas, A. et al. The Maudsley early onset schizophrenia study. Eur Child Adolesc Psychiatry 16, 465–470 (2007). https://doi.org/10.1007/s00787-007-0621-4

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