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Adolescent vs. adult onset of a first episode psychosis: Impact on remission of positive and negative symptoms

Schizophrenia Research, Volume 174, Issue 1-3, July 2016, Pages 183 - 188

Abstract

Objective

Adolescent-onset psychosis has traditionally been characterized as a more severe form of psychosis with a poorer prognosis. However, it is still unclear if patients with an adolescent-onset have worse symptom remission outcomes. Symptom remission is the principal clinical outcome known to predict quality of life and social functioning in the long term. The goal of this study is to clarify the influence of age of onset of psychosis on symptom remission in a sample of first-episode psychosis patients.

Method

A total of 246 first-episode psychosis patients were recruited from a specialized early intervention program serving a defined epidemiological catchment area. Age of onset of psychosis (adolescence vs. adulthood) was used as the main predictor, and duration of untreated psychosis (DUP), baseline symptoms, baseline functioning, substance abuse diagnosis, medication adherence and gender were used as covariates in hierarchical regression models predicting the following positive and negative symptom remission outcomes: maximum continuous months in remission and early remission (i.e., occurring in the first three months of follow-up).

Results

After controlling for other variables, onset of psychosis in adulthood and shorter DUP predicted early remission of positive symptoms. This effect was stronger in patients with a diagnosis of a schizophrenia-spectrum disorder. Remission of negative symptoms did not depend on age of onset, and was only predicted by baseline negative symptoms.

Conclusion

Patients with onset of psychosis during adulthood are more likely to achieve early positive symptom remission than those with adolescent onset. This effect might be stronger in patients with a diagnosis of a schizophrenia-spectrum disorder.

Abbreviations: CORS - Circumstances of Onset and Relapse Schedule, DUP - duration of untreated psychosis, LOCF - last observation carried forward, OR - odds ratio, PAS - Premorbid Adjustment Scale, PEPP - Prevention and Early Intervention Program for Psychosis Montreal, RSWG - Remission in Schizophrenia Working Group, SANS - Scale for the Assessment of Negative Symptoms, SAPS - Scale for the Assessment of Positive Symptoms, SCID-IV - Structured Clinical Interview for DSM-IV Axis I Disorders, SOFAS - Social and Occupational Functioning Assessment Scale, β - Standardized Beta Coefficient, VIF - variance inflation factor.

Keywords: First-episode-psychosis, Adolescence, Age at onset, Symptom remission, Multivariable regression.

Footnotes

Department of Psychiatry, McGill University, Canada

Douglas Mental Health University Institute, Canada

Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Canada

Corresponding author at: ACCESS Network Canada, Douglas Mental Health University Institute, 6625, Boul. LaSalle, Montréal, Québec H4H 1R3, Canada.