Table 1 Summary of the predictors and variables associated with outcome in early-onset psychosis
From: Predictors of outcome in early-onset psychosis: a systematic review
Multivariate analyses | Bivariate analyses | |
|---|---|---|
Clinical outcomes | ||
Diagnosis | A follow-up diagnosis of SSD predicted by: • More severe positive and negative symptoms and less severe affective and somatic symptoms at baseline35 • Poorer insight35 • More frequent history of obstetric complications35 • Lower IQ, lower scores in attention and global cognition, and greater motor impairment at baseline35 • Use of risperidone and aripiprazole and higher dose of antipsychotic treatment during FEP35 | A follow-up diagnosis of SSD associated with: • More severe positive symptoms at baseline22 • More severe negative symptoms at baseline84 and at discharge after an admission for FEP22 • More severe cognitive symptoms at baseline84 • Longer duration of the acute index episode22 • Regional GM volume deficits at baseline in left medial frontal and left middle frontal gyrus as compared with controls (versus left medial frontal cortex in BD I and bilateral insular and right occipital cortex in other psychotic disorders)85 • Increased temporal, parietal, and occipital sulcal width at baseline compared with controls (not found in BD I)53 |
Symptom type and severity | • Positive symptoms: More severe positive symptoms at follow-up predicted by more severe positive symptoms during acute episodes in childhood86 • Negative symptoms: More severe negative symptoms at follow-up predicted by more severe negative symptoms at baseline,28 more severe positive and negative symptoms during acute episodes in childhood,86 insidious onset,62 poorer premorbid functioning,86 and worse baseline social functioning28 • PANSS total: Higher scores at follow-up predicted by being female,28 more severe baseline negative symptoms,28 insidious onset,62 poorer premorbid adjustment,62 and worse baseline social functioning28,62 • Illness severity (CGI): Greater severity at follow-up predicted by insidious onset62 | Positive symptoms: • More severe symptoms at follow-up associated with a diagnosis of schizophrenia,48,87 greater premorbid emotional withdrawal,88 and positive family history of non-affective psychosis64 • Less severe symptoms at follow-up in baseline cannabis users versus cannabis non-users89 • Less improvement through follow-up in cannabis non-users versus cannabis users89 Negative symptoms: • More severe symptoms at follow-up associated with a diagnosis of schizophrenia,39,48,87 positive family history of non-affective psychosis,64 and lower baseline IQ90 • Less severe symptoms at follow-up in cannabis users versus non cannabis users89 Cognitive symptoms: More severe symptoms at follow-up associated with a diagnosis of schizophrenia84 Depressive symptoms: More severe symptoms at follow-up associated with a diagnosis of schizophrenia87 PANSS general: • More severe symptoms in patients with a diagnosis of schizophrenia87 • Less severe symptoms at follow-up in cannabis users versus cannabis non-users89 PANSS total: • Higher scores at follow-up associated with worse executive functioning, learning and memory, and global cognition at baseline91 • Less severe symptoms at follow-up in cannabis users versus cannabis non-users89 |
Course | Chronic course associated with a diagnosis of schizophrenia39,55,92 and being male31 | |
Remission | Short-term remission (12 weeks) predicted by: • Greater baseline cortical thickness in left prefrontal cortex, left superior and middle temporal gyri, and left and right postcentral and angular gyrus81 Remission status at follow-up (18 months to 42 years) predicted by: • Acute onset93 or shorter DUP50 • Higher baseline functioning (C-GAS)50 • No use of cannabis at baseline94 (although the effect disappeared after controlling for treatment adherence) | Short-term remission (8 weeks) associated with: • Being female95 • Better premorbid adjustment95 Remission status at follow-up (2 years) associated with: • Older age at onset26 • Acute onset26 • Less developmental and educational delays26 • Better premorbid adjustment26 • Less severe negative symptoms and behavioral problems at baseline26 • Higher IQ at baseline26 |
Relapse/readmission | A higher risk of relapse/readmission throughout follow-up predicted by: • Being female96 • Decline in social support before first admission96 | A diagnosis of SSD (versus acute transient psychotic disorders) associated with higher number and longer duration of admissions24 A higher risk for relapse/readmission throughout follow-up associated with: • More severe disorganization symptoms at discharge22 • Higher expressed emotion at discharge97 |
Treatment | Treatment adherence predicted by prescription of psychotropic treatment for affective symptoms (mood stabilizer or antidepressant) at baseline98 Quality of psychiatric care: In EOS, lower quality of psychiatric care predicted by delusions at baseline and lower age at onset,56 in EO-BD predicted by older age at onset56 | Treatment discontinuation for all causes associated with being male99 Higher likelihood of prescription of clozapine associated with longer duration of index hospitalization21 and being male21 |
Insight | In SSD, better insight predicted by shorter DUP, IQ at baseline (different direction of association depending on insight subdomain), and greater left frontal and parietal GM volume at baseline82 In non-SSD, predicted by sex and lower baseline severity of psychotic symptoms82 | Better insight associated with: • Non-SSD diagnosis82 • Better premorbid adjustment100 |
Suicidality | Suicide attempt predicted by: • Greater illness severity at baseline101 • More depressive symptoms87,101 and less severe negative symptoms102 at FEP | Completed suicide associated with: • Diagnosis of schizophrenia (versus BD)102 |
Functional outcomes | ||
Global functioning | Better global functioning at follow-up predicted by: • Non-schizophrenia diagnosis39,103 • Acute onset62 and shorter DUP50 • Negative family history of non-affective psychosis in EO-SSD103 • Absence of abnormal premorbid personality traits56,73,104 • Better premorbid adjustment50 and functioning27,55,56 • Better baseline functioning22,105 • Lower number of previous hospital admissions22 • Less severity of positive symptoms during acute episodes in childhood86 • Less severity of negative symptoms at baseline22,33,55,106 or during acute episodes in childhood86 • Less severe behavioral problems at baseline106 • Higher IQ in EOP103 and in EO-BD56,73 • Less impairment at discharge from the index hospitalization in EO-SSD104 • Better insight at baseline100 | Better global functioning at follow-up associated with: • Non-schizophrenia diagnosis24,47,55,84,87 • Being female64 • Older age at onset in EO-SSD63,64 • Negative family history of non-affective psychosis in EO-SSD64 • Absence of developmental disorder64,107 • Better premorbid adjustment108 and functioning63 • In EOS, more affective symptoms and paranoid subtype63 (versus worse functioning associated with disorganized subtype)63 • Better executive functioning109 and visual memory109 at baseline |
Social functioning | Better social functioning predicted by: • Older age at onset in EOS104 • Negative family history of non-affective psychosis in EO-BD56 • Lack of abnormal premorbid personality traits56,104 • Better social functioning at baseline28 • Less severity of negative symptoms at baseline28 • Higher baseline processing speed23 • Less impairment at discharge from the index hospitalization56,104 | Better social functioning associated with: • Non-schizophrenia diagnosis39,87,92,103 • Better premorbid adjustment108,110 • Lack of abnormal premorbid personality traits108 • Better baseline executive functioning,109 visuomotor processing,109 motor coordination,109 working memory,109 and verbal learning110 • Being in a romantic relationship negatively associated with a schizophrenia diagnosis (versus acute psychosis) and discharge against medical advice from index hospitalization21 |
Occupational/educational functioning | Better occupational/educational functioning predicted by: • Older age at onset in EO-SSD104 • Negative family history of non-affective psychosis for EO-BD56 • Better premorbid functioning56 • Absence of abnormal premorbid personality traits in EO-SSD56,104 • Shorter length of first admission30 • Less impairment at discharge for EO-SSD56,104,111 • No use of cannabis at baseline25 | Better occupational/educational functioning associated with: • Non-schizophrenia diagnosis39,48,87,92,103 • Being female21 • Better verbal memory, visuomotor processing, and visual attention at baseline109 • Shorter duration of FEP111 • Less severe residual symptoms111 and less impairment111 at discharge from the index episode |
Disability/dependency | Greater disability or dependency at follow-up predicted by: • Schizophrenia diagnosis56 • Positive family history of non-affective psychosis56 • Abnormal premorbid personality traits56,104 • Poorer premorbid social adjustment93 • More severe positive symptoms,30 greater impairment,104 and poorer social competence30 at discharge from the index hospitalization | Greater disability or dependency at follow-up associated with: • More premorbid emotional withdrawal88 • Lower age at onset72 • Schizophrenia diagnosis.21,48,103 A diagnosis of schizophrenia has also been associated with lower likelihood of living independently39,103 • Premorbid developmental disorder107 • Poorer verbal learning, working memory, and attention at baseline110 • More severe negative111 and total111 symptoms and greater impairment111 at discharge |
Quality of life | Better quality of life associated with a non-schizophrenia diagnosis87 | |
Composite clinical+functional outcomes | Better outcome (defined as CGAS>70 and clinical remission) associated with better premorbid adjustment, lower baseline negative and general PANSS, and higher baseline IQ26 | |
Cognitive outcomes | ||
Attention | Better attention at follow-up predicted by: • Cognitive reserve at baseline112 • Higher total antioxidant status at baseline78 | |
Working memory | Better working memory at follow-up predicted by: • Higher premorbid IQ and cognitive reserve at baseline112 | |
Learning and memory | Better learning and memory at follow-up predicted by: • Higher total antioxidant status at baseline78 | Better learning and memory at follow-up associated with: • Non-schizophrenia diagnosis (although association mediated by higher scores on PANSS)91 |
Executive function | Better executive functioning at follow-up predicted by: • Better premorbid adjustment29 • Lower scores in negative symptoms at baseline29 • In SSD, higher total antioxidant status at baseline78 Improvement in executive functioning throughout follow-up predicted by: • Lower negative symptoms at baseline29 • Shorter DUP29 | |
Global cognition | Better global cognition at follow-up predicted by: • Higher total antioxidant status at baseline78 | |
IQ | In SSD, follow-up IQ associated with GM volume at baseline113 | |
Neuroimaging outcomes | ||
Volume change | Greater frontal GM loss and CSF increase as compared with controls in EOS or psychosis NOS but not EO-BD114 Greater rate of GM loss throughout follow-up predicted by: • Baseline symptom severity115 • More premorbid developmental dysfunction115 Greater frontal, parietal, and temporal GM loss and total CSF volume increase throughout follow-up predicted by lower baseline GSH levels77 | Greater GM loss throughout follow-up associated with: • Being male116 • Baseline symptom severity116 • A diagnosis of COS but not psychosis NOS associated with frontal, temporal, and parietal GM loss117 • Temporal GM loss associated with baseline positive symptom severity118 • Hippocampal volume loss associated with baseline negative and positive symptom severity118 |
