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Signs and symptoms in the pre-psychotic phase: description and implications for diagnostic trajectories

Published online by Cambridge University Press:  26 March 2008

S. N. Iyer ,
L. Boekestyn ,
C. M. Cassidy ,
S. King ,
R. Joober  and
A. K. Malla
S. N. Iyer
Affiliation:
Douglas Mental Health University Institute, Montreal, Quebec, Canada Department of Psychiatry, McGill University, Montreal, Quebec, Canada
L. Boekestyn
Affiliation:
Douglas Mental Health University Institute, Montreal, Quebec, Canada
C. M. Cassidy
Affiliation:
Douglas Mental Health University Institute, Montreal, Quebec, Canada
S. King
Affiliation:
Douglas Mental Health University Institute, Montreal, Quebec, Canada Department of Psychiatry, McGill University, Montreal, Quebec, Canada
R. Joober
Affiliation:
Douglas Mental Health University Institute, Montreal, Quebec, Canada Department of Psychiatry, McGill University, Montreal, Quebec, Canada
A. K. Malla*
Affiliation:
Douglas Mental Health University Institute, Montreal, Quebec, Canada Department of Psychiatry, McGill University, Montreal, Quebec, Canada
*
*Address for correspondence: Dr A. K. Malla, Professor, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Montreal, Quebec H4H 1R3. (Email: ashok.malla@douglas.mcgill.ca)
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Abstract

Background

Few studies have examined the underlying factor structure of signs and symptoms occurring before the first psychotic episode. Our objective was to determine whether factors derived from early signs and symptoms are differentially associated with non-affective versus affective psychosis.

Method

A principal components factor analysis was performed on early signs and symptoms reported by 128 individuals with first-episode psychosis. Factor scores were examined for their associations with duration of untreated illness, drug abuse prior to onset of psychosis, and diagnosis (schizophrenia versus affective psychosis).

Results

Of the 27 early signs and symptoms reported by patients, depression and anxiety were the most frequent. Five factors were identified based on these early signs and symptoms: depression, disorganization/mania, positive symptoms, negative symptoms and social withdrawal. Longer duration of untreated illness was associated with higher levels of depression and social withdrawal. Individuals with a history of drug abuse prior to the onset of psychosis scored higher on pre-psychotic depression and negative symptoms. The two mood-related factors, depression and disorganization/mania, distinguished the eventual first-episode diagnosis of affective psychosis from schizophrenia. Individuals with affective psychosis were also more likely to have a ‘mood-related’ sign and symptom as their first psychiatric change than individuals later diagnosed with schizophrenia.

Conclusions

Factors derived from early signs and symptoms reported by a full diagnostic spectrum sample of psychosis can have implications for future diagnostic trajectories. The findings are a step forward in the process of understanding and characterizing clinically important phenomena to be observed prior to the onset of psychosis.

Keywords

Affective psychosisearly signsfactor analysisnon-affective psychosisprodrome
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 8 , August 2008 , pp. 1147 - 1156
Copyright
Copyright © 2008 Cambridge University Press

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References

Amminger, GP, Leicester, S, Yung, AR, Phillips, LJ, Berger, GE, Francey, SM, Yuen, HP, McGorry, PD (2006). Early-onset of symptoms predicts conversion to non-affective psychosis in ultra-high risk individuals. Schizophrenia Research 84, 67–76.CrossRefGoogle ScholarPubMed
Beiser, M, Erickson, D, Fleming, JA, Iacono, WG (1993). Establishing the onset of psychotic illness. American Journal of Psychiatry 150, 1349–1354.Google ScholarPubMed
Brenner, K, Schmitz, N, Pawliuk, N, Fathalli, F, Joober, R, Ciampi, A, King, S (2007). Validation of the English and French versions of the Community Assessment of Psychic Experiences (CAPE) with a Montreal community sample. Schizophrenia Research 95, 86–95.Google Scholar
Burger, GK, Calsyn, RJ, Morse, GA, Klinkenberg, WD, Trusty, ML (1997). Factor structure of the expanded Brief Psychiatric Rating Scale. Journal of Clinical Psychology 53, 451–454.Google Scholar
Compton, MT, West, JC, Olfson, M (2006). Prolonged duration of untreated psychosis in nonaffective first-episode psychotic disorders compared to other psychoses. International Journal of Psychiatry in Clinical Practice 10, 264–268.Google Scholar
Dingemans, PM, Linszen, DH, Lenior, ME, Smeets, RM (1995). Component structure of the expanded Brief Psychiatric Rating Scale (BPRS-E). Psychopharmacology (Berlin) 122, 263–267.CrossRefGoogle ScholarPubMed
Durdle, H, Lundahl, LH, Johanson, CE, Tancer, M (2007). Major depression: the relative contribution of gender, MDMA, and cannabis use. Depression and Anxiety. Published online: 7 March 2007. doi: 10.1002/da.20297.Google Scholar
Edwards, J, McGorry, PD, Waddell, FM, Harrigan, SM (1999). Enduring negative symptoms in first-episode psychosis: comparison of six methods using follow-up data. Schizophrenia Research 40, 147–158.CrossRefGoogle ScholarPubMed
Emsley, R, Rabinowitz, J, Torreman, M (2003). The factor structure for the Positive and Negative Syndrome Scale (PANSS) in recent-onset psychosis. Schizophrenia Research 61, 47–57.CrossRefGoogle ScholarPubMed
Emsley, RA, Oosthuizen, PP, Joubert, AF, Roberts, MC, Stein, DJ (1999). Depressive and anxiety symptoms in patients with schizophrenia and schizophreniform disorder. Journal of Clinical Psychiatry 60, 747–751.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JB (1997). Structured Clinical Interview for DSM-IV Axis I Disorders. American Psychiatric Press: Washington, DC.Google Scholar
Fresan, A, De la Fuente-Sandoval, C, Loyzaga, C, Garcia-Anaya, M, Meyenberg, N, Nicolini, H, Apiquian, R (2005). A forced five-dimensional factor analysis and concurrent validity of the Positive and Negative Syndrome Scale in Mexican schizophrenic patients. Schizophrenia Research 72, 123–129.CrossRefGoogle ScholarPubMed
Goldman, HH, Skodol, AE, Lave, TR (1992). Revising axis V for DSM-IV: a review of measures of social functioning. American Journal of Psychiatry 149, 1148–1156.Google ScholarPubMed
Gourzis, P, Katrivanou, A, Beratis, S (2002). Symptomatology of the initial prodromal phase in schizophrenia. Schizophrenia Bulletin 28, 415–429.CrossRefGoogle ScholarPubMed
Gross, G, Huber, G (1996). The true onset of schizophrenia in its meaning for the view of the disorder. Neurology Psychiatry and Brain Research 4, 93–102.Google Scholar
Hafner, H (2000). Onset and early course as determinants of the further course of schizophrenia. Acta Psychiatrica Scandinavica 102 (Suppl. 407), 44–48.Google Scholar
Hafner, H, Riecher-Rossler, A, Hambrecht, M, Maurer, K, Meissner, S, Schmidtke, A, Fatkenheuer, B, Loffler, W, van der Heiden, W (1992). IRAOS: an instrument for the assessment of onset and early course of schizophrenia. Schizophrenia Research 6, 209–223.CrossRefGoogle ScholarPubMed
Hambrecht, M, Lammertink, M, Klosterkotter, J, Matuschek, E, Pukrop, R (2002). Subjective and objective neuropsychological abnormalities in a psychosis prodrome clinic. British Journal of Psychiatry (Suppl.) 43, s30–s37.CrossRefGoogle Scholar
Hauser, M, Pfennig, A, Ozgurdal, S, Heinz, A, Bauer, M, Juckel, G (2007). Early recognition of bipolar disorder. European Psychiatry 22, 92–98.CrossRefGoogle ScholarPubMed
Hawkins, KA, McGlashan, TH, Quinlan, D, Miller, TJ, Perkins, DO, Zipursky, RB, Addington, J, Woods, SW (2004). Factorial structure of the Scale of Prodromal Symptoms. Schizophrenia Research 68, 339–347.CrossRefGoogle ScholarPubMed
Kitamura, T, Okazaki, Y, Fujinawa, A, Yoshino, M, Kasahara, Y (1995). Symptoms of psychoses. A factor-analytic study. British Journal of Psychiatry 166, 236–240.Google Scholar
Krystal, JH, D'Souza, DC, Gallinat, J, Driesen, N, Abi-Dargham, A, Petrakis, I, Heinz, A, Pearlson, G (2006). The vulnerability to alcohol and substance abuse in individuals diagnosed with schizophrenia. Neurotoxicity Research 10, 235–252.CrossRefGoogle ScholarPubMed
Lancon, C, Aghababian, V, Llorca, PM, Auquier, P (1998). Factorial structure of the Positive and Negative Syndrome Scale (PANSS): a forced five-dimensional factor analysis. Acta Psychiatrica Scandinavica 98, 369–376.Google Scholar
Lindenmayer, JP, Grochowski, S, Hyman, RB (1995). Five-factor model of schizophrenia: replication across samples. Schizophrenia Research 14, 229–234.CrossRefGoogle ScholarPubMed
Lykouras, L, Oulis, P, Psarros, K, Daskalopoulou, E, Botsis, A, Christodoulou, GN, Stefanis, C (2000). Five-factor model of schizophrenic psychopathology: how valid is it? European Archives of Psychiatry and Clinical Neuroscience 250, 93–100.CrossRefGoogle Scholar
Malla, A, Norman, R, Schmitz, N, Manchanda, R, Bechard-Evans, L, Takhar, J, Haricharan, R (2006). Predictors of rate and time to remission in first-episode psychosis: a two-year outcome study. Psychological Medicine 36, 649–658.CrossRefGoogle ScholarPubMed
Maziade, M, Roy, M-A, Martinez, M, Cliche, D, Fournier, JP, Garneau, Y, Nicole, L, Montgrain, N, Dion, C, Ponton, AM (1995). Negative, psychoticism, and disorganized dimensions in patients with familial schizophrenia or bipolar disorder: continuity and discontinuity between the major psychoses. American Journal of Psychiatry 152, 1458–1463.Google Scholar
McClellan, J, McCurry, C, Speltz, ML, Jones, K (2002). Symptom factors in early-onset psychotic disorder. Journal of the American Academy of Child and Adolescent Psychiatry 41, 791–798.CrossRefGoogle Scholar
McGorry, PD, Bell, RC, Dudgeon, PL, Jackson, HJ (1998). The dimensional structure of first-episode psychosis: an exploratory factor analysis. Psychological Medicine 28, 935–947.Google Scholar
McLeod, LD, Swygert, KA, Thissen, D (2001). Factor analysis for items scored in two categories. In Test Scoring (ed. Thissen, D. and Wainer, H.), pp. 189–216. Lawrence Erlbaum: Mahwah, NJ.Google Scholar
Meyer, SE, Bearden, CE, Lux, SR, Gordon, JL, Johnson, JK, O'Brien, MP, Niendam, TA, Loewy, RL, Ventura, J, Cannon, TD (2005). The psychosis prodrome in adolescent patients viewed through the lens of DSM-IV. Journal of Child and Adolescent Psychopharmacology 15, 434–451.CrossRefGoogle ScholarPubMed
Norman, RM, Scholten, DJ, Malla, AK, Ballageer, T (2005). Early signs in schizophrenia spectrum disorders. Journal of Nervous and Mental Disease 193, 17–23.CrossRefGoogle ScholarPubMed
Parry, CD, McArdle, JJ (1991). An applied comparison of methods for least-squared factor analysis of dichotomous variables. Applied Psychological Measurement 15, 35–46.Google Scholar
Peralta, V, Cuesta, MJ, Farre, C (1997). Factor structure of symptoms in functional psychoses. Biological Psychiatry 42, 806–815.CrossRefGoogle ScholarPubMed
Stefanis, NC, Hanssen, M, Smirnis, NK, Avramopoulos, DA, Evdokimidis, IK, Stefanis, CN, Verdoux, H, Van Os, J (2002). Evidence that three dimensions of psychosis have a distribution in the general population. Psychological Medicine 32, 347–358.Google Scholar
Svirskis, T, Korkeila, J, Heinimaa, M, Huttunen, J, Ilonen, T, Ristkari, T, McGlashan, T, Salokangas, RK (2005). Axis-I disorders and vulnerability to psychosis. Schizophrenia Research 75, 439–446.Google Scholar
Tan, HY, Ang, YG (2001). First-episode psychosis in the military: a comparative study of prodromal symptoms. Australian and New Zealand Journal of Psychiatry 35, 512–519.CrossRefGoogle ScholarPubMed
Thompson, KN, Conus, PO, Ward, JL, Phillips, LJ, Koutsogiannis, J, Leicester, S, McGorry, PD (2003). The initial prodrome to bipolar affective disorder: prospective case studies. Journal of Affective Disorders 77, 79–85.Google Scholar
Vaglum, P (1996). Earlier detection and intervention in schizophrenia: unsolved questions. Schizophrenia Bulletin 22, 347–351.CrossRefGoogle ScholarPubMed
van Nimwegen, L, de Haan, L, van Beveren, N, van den Brink, W, Linszen, D (2005). Adolescence, schizophrenia and drug abuse: a window of vulnerability. Acta Psychiatrica Scandinavica 111 (Suppl. 427), 35–42.CrossRefGoogle Scholar
Ventura, J, Nuechterlein, KH, Subotnik, KL, Gutkind, D, Gilbert, EA (2000). Symptom dimensions in recent-onset schizophrenia and mania: a principal components analysis of the 24-item Brief Psychiatric Rating Scale. Psychiatry Research 97, 129–135.CrossRefGoogle Scholar
Verdoux, H, Sorbara, F, Gindre, C, Swendsen, JD, Van Os, J (2003). Cannabis use and dimensions of psychosis in a nonclinical population of female subjects. Schizophrenia Research 59, 77–84.CrossRefGoogle Scholar
Yung, AR, McGorry, PD (1996). The prodromal phase of first-episode psychosis: past and current conceptualizations. Schizophrenia Bulletin 22, 353–370.CrossRefGoogle ScholarPubMed
Yung, AR, McGorry, PD, McFarlane, CA, Jackson, HJ, Patton, GC, Rakkar, A (1996). Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin 22, 283–303.CrossRefGoogle ScholarPubMed
Yung, AR, Phillips, LJ, McGorry, PD, McFarlane, CA, Francey, S, Harrigan, S, Patton, GC, Jackson, HJ (1998). Prediction of psychosis. A step towards indicated prevention of schizophrenia. British Journal of Psychiatry (Suppl.) 172, 14–20.CrossRefGoogle ScholarPubMed