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Developmental influences on symptom expression in antipsychotic-naïve first-episode psychosis

Published online by Cambridge University Press:  06 October 2020

Miranda Bridgwater Open the ORCID record for Miranda Bridgwater [Opens in a new window] ,
Peter Bachman Open the ORCID record for Peter Bachman [Opens in a new window] ,
Brenden Tervo-Clemmens ,
Gretchen Haas Open the ORCID record for Gretchen Haas [Opens in a new window] ,
Rebecca Hayes ,
Beatriz Luna Open the ORCID record for Beatriz Luna [Opens in a new window] ,
Dean F. Salisbury Open the ORCID record for Dean F. Salisbury [Opens in a new window]  and
Maria Jalbrzikowski Open the ORCID record for Maria Jalbrzikowski [Opens in a new window]
Miranda Bridgwater
Affiliation:
Department of Psychology, University of Maryland, Baltimore County, Maryland, USA
Peter Bachman
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Brenden Tervo-Clemmens
Affiliation:
Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
Gretchen Haas
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA VISN4 MIRECC at VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
Rebecca Hayes
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Beatriz Luna
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
Dean F. Salisbury
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Maria Jalbrzikowski*
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
*
Author for correspondence: Maria Jalbrzikowski, E-mail: jalbrzikowskime@upmc.edu
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Abstract

Background

The neurodevelopmental model of psychosis was established over 30 years ago; however, the developmental influence on psychotic symptom expression – how age affects clinical presentation in first-episode psychosis – has not been thoroughly investigated.

Methods

Using generalized additive modeling, which allows for linear and non-linear functional forms of age-related change, we leveraged symptom data from a large sample of antipsychotic-naïve individuals with first-episode psychosis (N = 340, 12–40 years, 1–12 visits), collected at the University of Pittsburgh from 1990 to 2017. We examined relationships between age and severity of perceptual and non-perceptual positive symptoms and negative symptoms. We tested for age-associated effects on change in positive or negative symptom severity following baseline assessment and explored the time-varying relationship between perceptual and non-perceptual positive symptoms across adolescent development.

Results

Perceptual positive symptom severity significantly decreased with increasing age (F = 7.0, p = 0.0007; q = 0.003) while non-perceptual positive symptom severity increased with age (F = 4.1, p = 0.01, q = 0.02). Anhedonia severity increased with increasing age (F = 6.7, p = 0.00035; q = 0.0003), while flat affect decreased in severity with increased age (F = 9.8, p = 0.002; q = 0.006). Findings remained significant when parental SES, IQ, and illness duration were included as covariates. There were no developmental effects on change in positive or negative symptom severity (all p > 0.25). Beginning at age 18, there was a statistically significant association between severity of non-perceptual and perceptual symptoms. This relationship increased in strength throughout adulthood.

Conclusions

These findings suggest that as maturation proceeds, perceptual symptoms attenuate while non-perceptual symptoms are enhanced. Findings underscore how pathological brain–behavior relationships vary as a function of development.

Keywords

Adolescenceage effectsantipsychotic-naïveschizophreniapsychotic symptoms
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 9 , July 2022 , pp. 1698 - 1709
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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