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The affective dimension of early-onset psychosis and its relationship with suicide.
J Child Psychol Psychiatry. 2015 Jul; 56(7):747-755.JC

Abstract

BACKGROUND

The affective dimension has scarcely been studied in early-onset psychosis. Our aims were to investigate the prevalence and type of affective symptoms in the prodromal and acute phases of early-onset psychosis and to examine their relationship with suicide. We also sought to establish whether the presence of premorbid antecedents or the presence of affective symptoms during the prodromal and acute phase might predict a later diagnosis of bipolar disorder (BP) or schizophrenia (SZ).

METHOD

Participants were 95 youths, aged 9-17 years, experiencing a first episode of a psychotic disorder (FEP) according to DSM-IV criteria. Prodromal affective symptoms in the year prior to the onset of full-blown psychosis were assessed by means of the K-SADS. Affective symptoms during the acute episode were evaluated using the Hamilton Depression Rating Scale and the Young Mania Rating Scale. Suicidality was assessed during the acute episode and at 6 and 12 months.

RESULTS

Half of the patients experienced affective symptoms during the prodrome, with depressive symptoms being the most frequently reported. During the acute episode, 23.2% presented depressive, 41.4% mixed and 18.9% manic symptoms. After logistic regression analysis, only the presence of depressive symptoms was significantly associated with suicidality during the 12 months following the FEP. Neither early premorbid antecedents nor the prevalence or type of affective symptoms during the FEP predicted a diagnosis of BP or SZ at 12 months. However, both depressive and manic prodromal symptoms were associated with a later diagnosis of BP.

CONCLUSIONS

The FEP of both SZ and BP is preceded by an identifiable prodromal phase. Early detection programs should target young people at clinical risk for the extended psychosis phenotype. The high prevalence of affective symptoms during the early phases of psychosis may encourage clinicians to identify and treat them in order to prevent suicide behaviour.

Authors+Show Affiliations

Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Institute Clinic of Neurosciences, University of Barcelona, Barcelona, 2009-SGR-1119, Generalitat de Catalunya, Barcelona, Spain. Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Institute Clinic of Neurosciences, University of Barcelona, Barcelona, 2009-SGR-1119, Generalitat de Catalunya, Barcelona, Spain. Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain. Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain.Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain. Department of Psychiatry, Hospital Santiago Apóstol, EHU/University of the Basque Country, Vitoria, Spain.Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain. Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain.Department of Child and Adolescent Psychiatry and Psychology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain. Child and Adolescent Mental Health Unit, Department of Psychiatry and Psychology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain. Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain.Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Institute Clinic of Neurosciences, University of Barcelona, Barcelona, 2009-SGR-1119, Generalitat de Catalunya, Barcelona, Spain. Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25256792

Citation

Sanchez-Gistau, Vanessa, et al. "The Affective Dimension of Early-onset Psychosis and Its Relationship With Suicide." Journal of Child Psychology and Psychiatry, and Allied Disciplines, vol. 56, no. 7, 2015, pp. 747-755.
Sanchez-Gistau V, Baeza I, Arango C, et al. The affective dimension of early-onset psychosis and its relationship with suicide. J Child Psychol Psychiatry. 2015;56(7):747-755.
Sanchez-Gistau, V., Baeza, I., Arango, C., González-Pinto, A., de la Serna, E., Parellada, M., Graell, M., Paya, B., Llorente, C., & Castro-Fornieles, J. (2015). The affective dimension of early-onset psychosis and its relationship with suicide. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 56(7), 747-755. https://doi.org/10.1111/jcpp.12332
Sanchez-Gistau V, et al. The Affective Dimension of Early-onset Psychosis and Its Relationship With Suicide. J Child Psychol Psychiatry. 2015;56(7):747-755. PubMed PMID: 25256792.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The affective dimension of early-onset psychosis and its relationship with suicide. AU - Sanchez-Gistau,Vanessa, AU - Baeza,Inmaculada, AU - Arango,Celso, AU - González-Pinto,Ana, AU - de la Serna,Elena, AU - Parellada,Mara, AU - Graell,Montserrat, AU - Paya,Beatriz, AU - Llorente,Cloe, AU - Castro-Fornieles,Josefina, Y1 - 2014/09/26/ PY - 2014/09/01/accepted PY - 2014/9/27/entrez PY - 2014/9/27/pubmed PY - 2016/3/5/medline KW - Psychosis KW - depression KW - suicidality SP - 747 EP - 755 JF - Journal of child psychology and psychiatry, and allied disciplines JO - J Child Psychol Psychiatry VL - 56 IS - 7 N2 - BACKGROUND: The affective dimension has scarcely been studied in early-onset psychosis. Our aims were to investigate the prevalence and type of affective symptoms in the prodromal and acute phases of early-onset psychosis and to examine their relationship with suicide. We also sought to establish whether the presence of premorbid antecedents or the presence of affective symptoms during the prodromal and acute phase might predict a later diagnosis of bipolar disorder (BP) or schizophrenia (SZ). METHOD: Participants were 95 youths, aged 9-17 years, experiencing a first episode of a psychotic disorder (FEP) according to DSM-IV criteria. Prodromal affective symptoms in the year prior to the onset of full-blown psychosis were assessed by means of the K-SADS. Affective symptoms during the acute episode were evaluated using the Hamilton Depression Rating Scale and the Young Mania Rating Scale. Suicidality was assessed during the acute episode and at 6 and 12 months. RESULTS: Half of the patients experienced affective symptoms during the prodrome, with depressive symptoms being the most frequently reported. During the acute episode, 23.2% presented depressive, 41.4% mixed and 18.9% manic symptoms. After logistic regression analysis, only the presence of depressive symptoms was significantly associated with suicidality during the 12 months following the FEP. Neither early premorbid antecedents nor the prevalence or type of affective symptoms during the FEP predicted a diagnosis of BP or SZ at 12 months. However, both depressive and manic prodromal symptoms were associated with a later diagnosis of BP. CONCLUSIONS: The FEP of both SZ and BP is preceded by an identifiable prodromal phase. Early detection programs should target young people at clinical risk for the extended psychosis phenotype. The high prevalence of affective symptoms during the early phases of psychosis may encourage clinicians to identify and treat them in order to prevent suicide behaviour. SN - 1469-7610 UR - https://www.unboundmedicine.com/medline/citation/25256792/The_affective_dimension_of_early_onset_psychosis_and_its_relationship_with_suicide_ L2 - https://doi.org/10.1111/jcpp.12332 DB - PRIME DP - Unbound Medicine ER -