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A follow-up study of early onset psychosis: Comparison between outcome diagnoses of schizophrenia, mood disorders, and personality disorders

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Abstract

This study examined the outcome of youth previously diagnosed with psychotic disorders at a public-sector tertiary care hospital. Of 95 children and adolescents retrospectively identified, follow-up information (mean interval 3.9 years) was obtained on 24 subjects with an outcome diagnosis of schizophrenia, 9 with psychotic mood disorders, 5 with personality disorders (antisocial or borderline), and 1 with schizo-affective disorder. The schizophrenic group was more often odd premorbidly and functioned worse at outcome, while the mood-disordered group had a shorter follow-up period and was more often anxious or dysthymic premorbidly. The personality-disordered group resembled the schizophrenics in their degree of impairment and chronicity. All three groups had high rates of family disruption, low SES, substance abuse, and chronicity, and were similar in their degree of premorbid impairment, length of prodrome, age of onset, initial diagnosis, and family psychiatric history. Misdiagnosis at onset was quite common and highlights the need for systematic longitudinal assessment of early onset psychotic disorders.

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References

  • American Psychiatric Association. (1987).Diagnostic and statistical manual of mental disorder (3rd ed., rev.). Washington, DC: Author.

    Google Scholar 

  • Andreasen, N. (1982). The scales for the assessment of positive and negative symptoms. Iowa City: University of Iowa.

    Google Scholar 

  • Apter, A., Bleich, A., & Tyano, S. (1988). Affective and Psychotic Psychopathology in Hospitalized Adolescents.Journal of the American Academy of Child and Adolescent Psychiatry, 27, 116–120.

    PubMed  Google Scholar 

  • Asarnow, J. R., & Ben-Meir, S. (1988). Children with schizophrenia spectrum and depressive disorders: A comparative study of premorbid adjustment, onset pattern and severity of impairment.Journal of Child Psychology and Psychiatry, 29, 477–488.

    PubMed  Google Scholar 

  • Bashir, M., Russell, J., & Johnson, G. (1987). Bipolar affective disorder in adolescence: A 10 year study.Australian and New Zealand Journal of Psychiatry, 21, 36–43.

    PubMed  Google Scholar 

  • Ballenger, J. C., Reus, V. I., & Post, R. M. (1982). The “atypical” clinical picture of adolescent mania.American Journal of Psychiatry, 139, 602–606.

    PubMed  Google Scholar 

  • Beitchman, J. H. (1985). Childhood schizophrenia: A review and comparison with adult-onset schizophrenia.Psychiatric Clinics of North America, 8, 793–814.

    PubMed  Google Scholar 

  • Bettes, B. A., & Walker, E. (1987). Positive and negative symptoms in psychotic and other psychiatrically disturbed children.Journal of Child Psychology and Psychiatry, 28, 555–567.

    PubMed  Google Scholar 

  • Brent, D. A., Zelenak, J. P., Bukstein, O., & Brown, R. V. (1990). Reliability and validity of the structured interview for personality disorders in adolescents.Journal of the American Academy of Child and Adolescent Psychiatry, 29, 349–354.

    PubMed  Google Scholar 

  • Cantor, S., Evans, J., Pearce, J., et al. (1982). Childhood Schizophrenia, present but not accounted for.American Journal of Psychiatry, 139, 758–762.

    PubMed  Google Scholar 

  • Carlson, G. A. (1990a). Bipolar disorder in children and adolescents. In B. D. Garfinkle, G. A. Carlson, & E. B. Weller (Eds.),Psychiatric disorders in children and adolescents (pp. 21–37) Philadelphia, PA: W. B. Saunders.

    Google Scholar 

  • Carlson, G. A. (1990b). Child and adolescent mania: Diagnostic considerations.Journal of Child Psychology and Psychiatry, 31, 331–342.

    PubMed  Google Scholar 

  • Carlson, G. A., & Kashani, J. H. (1988). Phenomenology of major depression from childhood through adulthood: Analysis of three studies.American Journal of Psychiatry, 145, 1222–1225.

    PubMed  Google Scholar 

  • Carlson, G. A., & Strober, M. (1978). Manic-depressive illness in early adolescence. A study of clinical and diagnostic characteristics in six cases.Journal of the American Academy of Child Psychiatry, 17, 138–153.

    PubMed  Google Scholar 

  • Chambers, W. J., Puig-Antich, J., Tabrizi, M. A., & Davies, M. (1982). Psychotic symptoms in prepubertal major depressive disorder.Archives of General Psychiatry, 39, 921–927.

    PubMed  Google Scholar 

  • Chu, J. A., & Dill, D. L. (1990). Dissociative symptoms in relation to childhood physical and sexual abuse.American Journal of Psychiatry, 147, 887–892.

    PubMed  Google Scholar 

  • Del Beccaro, M. A., Burke, P., & McCauley, E. (1988). Hallucinations in children, a follow-up study.Journal of the American Academy of Child and Adolescent Psychiatry, 27, 462–465.

    PubMed  Google Scholar 

  • Eggers, C. (1989). Schizo-affection Psychoses in Childhood: A follow-up study.Journal of Autism and Developmental Disorders, 19, 327–342.

    PubMed  Google Scholar 

  • Eggers, C. (1978). Course and prognosis in childhood schizophrenia.Journal of Autism and Childhood Schizophrenia, 8, 21–36.

    PubMed  Google Scholar 

  • Garralda, M. E. (1984a). Hallucinations in children with conduct and emotional disorders: I. The clinical phenomena.Psychological Medicine, 14, 589–596.

    PubMed  Google Scholar 

  • Garralda, M. E. (1984b). Hallucinations in children with conduct and emotional disorders: II. the follow-up study.Psychological Medicine, 14, 597–604.

    PubMed  Google Scholar 

  • Garralda, M. E. (1985). Characteristics of the psychoses of late onset in children and adolescents (A comparative study of hallucinating children).Journal of Adolescence, 8, 195–207.

    PubMed  Google Scholar 

  • Grebb, J. A., & Cancro, R. (1989). Schizophrenia, clinical features. In H. I. Kaplan & J. Sadock (Eds.),Comprehensive textbook of psychiatry (5th ed., p. 768). Baltimore, MD: Williams and Wilkins.

    Google Scholar 

  • Green, W. H., & Padron-Gayol, M. (1986). Schizophrenic disorder in childhood: Its relationship to DSM-III criteria. In C. Shagass (ed.),Biological psychiatry (pp. 1484–1486). Amsterdam: Elsevier.

    Google Scholar 

  • Gunderson, J. G. (1988). Personality disorders. In A. M. Nicholi, Jr. (Ed.),The new Harvard guide to psychiatry (pp. 337–357). Cambridge, MA: Belnap.

    Google Scholar 

  • Gunderson, J. G., & Phillips, K. A. (1991). A current view of the interface between borderline personality disorder and depression.American Journal of Psychiatry, 148, 967–975.

    PubMed  Google Scholar 

  • Joyce, P. R. (1984). Age of onset in bipolar affective disorder and misdiagnosis of schizophrenia.Psychological Medicine, 14, 145–149.

    PubMed  Google Scholar 

  • Kolvin, I. (1971). Studies in the childhood psychoses.British Journal of Psychiatry, 118, 209–234.

    Google Scholar 

  • Kutcher, S. P., Marton, P., & Korenblum, M. (1990). Adolescent bipolar illness and disorder.Journal of the American Academy of Child and Adolescent Psychiatry, 29, 355–358.

    PubMed  Google Scholar 

  • Kydd, R. R., & Werry, J. S. (1982). Schizophrenia in children under 16 years.Journal of Autism and Developmental Disorders, 12, 343–357.

    PubMed  Google Scholar 

  • Lewis, M. (1990).Borderline syndromes. Institute on Psychosis in Childhood and Adolescence. Presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry, Chicago IL.

  • Liebowitz, M. R. (1989). Somatic therapy for personality disorders. InTreatments of psychiatric disorders, a task force report of the American Psychiatric Association (Vol. 3, pp. 2678–2688). Washington, DC: APA Press.

    Google Scholar 

  • Lofgren, D. P., Bemporad, J., King, J., Lindem, K., & O'Driscoll, G. (1991). A prospective follow-up study of so called borderline children.American Journal of Psychiatry, 148, 1541–1547.

    PubMed  Google Scholar 

  • McClellan, J. M., & Werry, J. S. (1992). Schizophrenia.Psychiatric Clinics of North America, 15, 131–148.

    PubMed  Google Scholar 

  • McGlashan, T. H. (1988). Adolescent versus adult onset of mania.American Journal of Psychiatry, 145, 221–223.

    PubMed  Google Scholar 

  • Nurcombe, B. (1990).Dissociative hallucinosis and allied conditions. Presented at the Institute on Psychosis in Childhood and Adolescence, Annual meeting of the American Academy of Child and Adolescent Psychiatry, Chicago, IL.

  • Overall, J. E., & Gorham, D. R. (1962). The brief psychiatric rating scale.Psychological Reports, 10, 799–812.

    Google Scholar 

  • Pataki, C. S., & Carlson, G. A. (1990). Affective disorders in children and adolescents. In B. J. Tonge, G. D. Burrows, & J. S. Werry (Eds.),Handbook of studies on child psychiatry (pp. 136–160). Amsterdam: Elsevier.

    Google Scholar 

  • Russell, A. T., Bott, L., & Sammons, C. (1989). The phenomenology of schizophrenia occurring in childhood.Journal of the American Academy of Child and Adolescent Psychiatry, 28, 399–407.

    PubMed  Google Scholar 

  • Ryan, N. D., Puig-Antich, J., Ambrosini, P., Rabinovich, H., Robinson, D., Nelson, B., Iyengar, S., & Twomey, J. (1987). The clinical picture of major depression in children and adolescents.Archives of General Psychiatry, 44, 854–861.

    PubMed  Google Scholar 

  • Spitzer, R. L., Williams, J. B., Gibbons, M., & First, M. (1988). The structured clinical interview for DSM-III-R (SCID, 01/88, Revision). New York: New York State Psychiatric Research Institute.

    Google Scholar 

  • Steinberg, D. (1985). Psychotic and other severe disturbances in adolescence. In M. Rutter & L. Herzov (Eds.),Child and adolescent psychiatry, modern approaches (pp. 567–583). Oxford, Blackwell.

    Google Scholar 

  • Watkins, J. M., Asarnow, R. F., & Tanguay, P. (1988). Symptom development in childhood onset schizophrenia.Journal of Child Psychology and Psychiatry, 29, 865–878.

    PubMed  Google Scholar 

  • Weiner, H., Cancro, R., Lehmann, H. E., & Frazier, S. H. (1989). The concept of a disease: Schizophrenia. InTreatments of psychiatric disorders, a task force report of the American Psychiatric Association (Vol. 2, pp. 1489–1492). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Weller, E. B. (1990).Affective disorders. Institute on Psychosis in Childhood and Adolescence. Presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry, Chicago, IL.

  • Weller, E. B., & Weller, R. A. (1990). Depressive disorders in children and adolescents. In B. D. Garfinkle, G. A. Carlson, & E. B. Weller (Eds.),Psychiatric disorders in children and adolescents (pp. 37–48). Philadelphia, PA: W. B. Saunders.

    Google Scholar 

  • Werry, J. S. (1992). Child and adolescent (early onset) schizophrenia: A review in light of DSM-III-R.Journal of Autism and Developmental Disorders, 22, 601–624.

    PubMed  Google Scholar 

  • Werry, J. S., & McClellan, J. (1992). Predicting outcome in child and adolescent (early onset) schizophrenia and bipolar disorder.Journal of the American Academy of Child and Adolescent Psychiatry, 31, 147–150.

    PubMed  Google Scholar 

  • Werry, J. S., McClellan, J., Andrews, L., & Ham, M. (1993). Some clinical and outcome studies of early onset schizophrenia. Manuscript submitted for publication.

  • Werry, J. S., McClellan, J., & Chard, L. (1991). Early onset schizophrenia, bipolar and schizo-affective disorders: A clinical and follow-up study.Journal of the American Academy of Child and Adolescent Psychiatry, 30, 457–465.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. University of Auckland, Auckland

    John S. Werry

  2. The Human Development Center, Duluth, Minnesota

    Mark Ham

  3. Department of Psychiatry, RP-10, University of Washington, 98109, Seattle, Washington

    Jon M. McClellan

Authors
  1. Jon M. McClellan
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  2. John S. Werry
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  3. Mark Ham
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This study was funded in part by a grant from the Washington Institute for Research and Training.

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McClellan, J.M., Werry, J.S. & Ham, M. A follow-up study of early onset psychosis: Comparison between outcome diagnoses of schizophrenia, mood disorders, and personality disorders. J Autism Dev Disord 23, 243–262 (1993). https://doi.org/10.1007/BF01046218

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