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Conversion to psychosis in adolescents and adults: similar proportions, different predictors

Published online by Cambridge University Press:  06 April 2020

TianHong Zhang ,
LiHua Xu ,
Ying Chen ,
YanYan Wei ,
XiaoChen Tang ,
YeGang Hu ,
ZhiXing Li ,
RanPiao Gan ,
GuiSen Wu  and
HuiRu Cui
...Show all authors
TianHong Zhang
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
LiHua Xu
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
Ying Chen
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
YanYan Wei
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
XiaoChen Tang
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
YeGang Hu
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
ZhiXing Li
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
RanPiao Gan
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
GuiSen Wu
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
HuiRu Cui
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
YingYing Tang
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
Li Hui
Affiliation:
Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Soochow University, Suzhou215137, Jiangsu, PR China
ChunBo Li
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
JiJun Wang*
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai, PR China Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
*
Author for correspondence: JiJun Wang, E-mail: jijunwang27@163.com
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Abstract

Background

Age effects may be important for improving models for the prediction of conversion to psychosis for individuals in the clinical high risk (CHR) state. This study aimed to explore whether adolescent CHR individuals (ages 9–17 years) differ significantly from adult CHR individuals (ages 18–45 years) in terms of conversion rates and predictors.

Method

Consecutive CHR individuals (N = 517) were assessed for demographic and clinical characteristics and followed up for 3 years. Individuals with CHR were classified as adolescent (n = 244) or adult (n = 273) groups. Age-specific prediction models of psychosis were generated separately using Cox regression.

Results

Similar conversion rates were found between age groups; 52 out of 216 (24.1%) adolescent CHR individuals and 55 out of 219 (25.1%) CHR adults converted to psychosis. The conversion outcome was best predicted by negative symptoms compared to other clinical variables in CHR adolescents (χ2 = 7.410, p = 0.006). In contrast, positive symptoms better predicted conversion in CHR adults (χ2 = 6.585, p = 0.01).

Conclusions

Adolescent and adult CHR individuals may require a different approach to early identification and prediction. These results can inform the development of more precise prediction models based on age-specific approaches.

Keywords

Cohort studyearly onsetschizophreniatransitionultra high risk
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 12 , September 2021 , pp. 2003 - 2011
Copyright
Copyright © The Author(s) 2020. Published by Cambridge University Press

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References

Addington, J., Cadenhead, K. S., Cannon, T. D., Cornblatt, B., McGlashan, T. H., Perkins, D. O., … Heinssen, R. (2007). North American Prodrome Longitudinal Study: A collaborative multisite approach to prodromal schizophrenia research. Schizophrenia Bulletin, 33(3), 665–672. doi: sbl075 [pii]10.1093/schbul/sbl075CrossRefGoogle ScholarPubMed
Addington, J., Cornblatt, B. A., Cadenhead, K. S., Cannon, T. D., McGlashan, T. H., Perkins, D. O., … Heinssen, R. (2011). At clinical high risk for psychosis: Outcome for nonconverters. The American Journal of Psychiatry, 168(8), 800–805. doi: appi.ajp.2011.10081191 [pii]10.1176/appi.ajp.2011.10081191CrossRefGoogle ScholarPubMed
Ballageer, T., Malla, A., Manchanda, R., Takhar, J., & Haricharan, R. (2005). Is adolescent-onset first-episode psychosis different from adult onset? Journal of the American Academy of Child and Adolescent Psychiatryy, 44(8), 782–789. doi: 10.1097/01.chi.0000164591.55942.eaCrossRefGoogle ScholarPubMed
Biswas, P., Malhotra, S., Malhotra, A., & Gupta, N. (2007). Comparative study of neurological soft signs in schizophrenia with onset in childhood, adolescence and adulthood. Acta Psychiatrica Scandinavica, 115(4), 295–303. doi: 10.1111/j.1600-0447.2006.00901.xCrossRefGoogle Scholar
Cannon, T. D., Cadenhead, K., Cornblatt, B., Woods, S. W., Addington, J., Walker, E., … Heinssen, R. (2008). Prediction of psychosis in youth at high clinical risk: A multisite longitudinal study in North America. Archives of General Psychiatry, 65(1), 28–37. doi: 10.1001/archgenpsychiatry.2007.3CrossRefGoogle ScholarPubMed
Cannon, T. D., Yu, C., Addington, J., Bearden, C. E., Cadenhead, K. S., Cornblatt, B. A., … Kattan, M. W. (2016). An individualized risk calculator for research in prodromal psychosis. The American Journal of Psychiatry, 173(10), 980–988. doi: 10.1176/appi.ajp.2016.15070890CrossRefGoogle ScholarPubMed
Collin, G., Seidman, L. J., Keshavan, M. S., Stone, W. S., Qi, Z., Zhang, T., … Whitfield-Gabrieli, S. (2018). Functional connectome organization predicts conversion to psychosis in clinical high-risk youth from the SHARP program. Molecular Psychiatry. doi: 10.1038/s41380-018-0288-xGoogle ScholarPubMed
Driver, D. I., Thomas, S., Gogtay, N., & Rapoport, J. L. (2020). Childhood-onset schizophrenia and early-onset schizophrenia spectrum disorders: An update. Child and Adolescent Psychiatric Clinics of North America, 29(1), 71–90. doi: 10.1016/j.chc.2019.08.017CrossRefGoogle ScholarPubMed
Fusar-Poli, P., Bonoldi, I., Yung, A. R., Borgwardt, S., Kempton, M. J., Valmaggia, L., … McGuire, P. (2012). Predicting psychosis: Meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry, 69(3), 220–229. doi: 10.1001/archgenpsychiatry.2011.1472CrossRefGoogle ScholarPubMed
Fusar-Poli, P., Borgwardt, S., Bechdolf, A., Addington, J., Riecher-Rossler, A., Schultze-Lutter, F., … Yung, A. (2013). The psychosis high-risk state: A comprehensive state-of-the-art review. JAMA Psychiatry, 70(1), 107–120. doi: 10.1001/jamapsychiatry.2013.269CrossRefGoogle ScholarPubMed
Fusar-Poli, P., Borgwardt, S., & Valmaggia, L. (2008). Heterogeneity in the assessment of the at-risk mental state for psychosis. Psychiatric Services, 59(7), 813. doi: 10.1176/appi.ps.59.7.813. 10.1176/ps.2008.59.7.813CrossRefGoogle ScholarPubMed
Fusar-Poli, P., Cappucciati, M., Borgwardt, S., Woods, S. W., Addington, J., Nelson, B., … McGuire, P. K. (2016). Heterogeneity of psychosis risk within individuals at clinical high risk: A meta-analytical stratification. JAMA Psychiatry, 73(2), 113–120. doi: 10.1001/jamapsychiatry.2015.2324CrossRefGoogle ScholarPubMed
Fusar-Poli, P., Stringer, D., M S Durieux, A., Rutigliano, G., Bonoldi, I., De Micheli, A., Stahl, D. (2019). Clinical-learning versus machine-learning for transdiagnostic prediction of psychosis onset in individuals at-risk. Translational Psychiatry, 9(1), 259. doi: 10.1038/s41398-019-0600-9CrossRefGoogle ScholarPubMed
Gomes, F. V., Rincon-Cortes, M., & Grace, A. A. (2016). Adolescence as a period of vulnerability and intervention in schizophrenia: Insights from the MAM model. Neuroscience and Biobehavioral Reviews, 70, 260–270. doi: 10.1016/j.neubiorev.2016.05.030CrossRefGoogle ScholarPubMed
Hollis, C. (2003). Developmental precursors of child- and adolescent-onset schizophrenia and affective psychoses: Diagnostic specificity and continuity with symptom dimensions. The British Journal of Psychiatry, 182, 37–44. doi: 10.1192/bjp.182.1.37CrossRefGoogle ScholarPubMed
Jalbrzikowski, M., Sugar, C. A., Zinberg, J., Bachman, P., Cannon, T. D., & Bearden, C. E. (2014). Coping styles of individuals at clinical high risk for developing psychosis. Early Intervention in Psychiatry, 8(1), 68–76. doi: 10.1111/eip.12005CrossRefGoogle ScholarPubMed
Kahn, R. S., Sommer, I. E., Murray, R. M., Meyer-Lindenberg, A., Weinberger, D. R., Cannon, T. D., … Insel, T. R. (2015). Schizophrenia. Nature Reviews. Disease Primers, 1, 15067. doi: 10.1038/nrdp.2015.67CrossRefGoogle ScholarPubMed
Lay, B., Blanz, B., Hartmann, M., & Schmidt, M. H. (2000). The psychosocial outcome of adolescent-onset schizophrenia: A 12-year followup. Schizophrenia Bulletin, 26(4), 801–816. doi: 10.1093/oxfordjournals.schbul.a033495CrossRefGoogle ScholarPubMed
Lemos-Giraldez, S., Vallina-Fernandez, O., Fernandez-Iglesias, P., Vallejo-Seco, G., Fonseca-Pedrero, E., Paino-Pineiro, M., … Ortega-Ferrandez, J. A. (2009). Symptomatic and functional outcome in youth at ultra-high risk for psychosis: A longitudinal study. Schizophrenia Research, 115(2-3), 121–129. doi: S0920-9964(09)00430-7 [pii]10.1016/j.schres.2009.09.011CrossRefGoogle ScholarPubMed
Li, H., Zhang, T., Xu, L., Tang, Y., Cui, H., Wei, Y., … Wang, J. (2018). A comparison of conversion rates, clinical profiles and predictors of outcomes in two independent samples of individuals at clinical high risk for psychosis in China. Schizophrenia Research, 197, 509–515. doi: 10.1016/j.schres.2017.11.029CrossRefGoogle ScholarPubMed
McGlashan, T., Walsh, B., & Woods, S. (2010). The psychosis-risk syndrome: Handbook for diagnosis and follow-up. New York: Oxford University Press.Google Scholar
Miller, T. J., McGlashan, T. H., Rosen, J. L., Cadenhead, K., Cannon, T., Ventura, J., … Woods, S. W. (2003). Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: Predictive validity, interrater reliability, and training to reliability. Schizophrenia Bulletin, 29(4), 703–715.CrossRefGoogle ScholarPubMed
Pencer, A., Addington, J., & Addington, D. (2005). Outcome of a first episode of psychosis in adolescence: A 2-year follow-up. Psychiatry Research, 133(1), 35–43. doi: 10.1016/j.psychres.2004.10.004CrossRefGoogle ScholarPubMed
Petruzzelli, M. G., Margari, L., Bosco, A., Craig, F., Palumbi, R., & Margari, F. (2018). Early onset first episode psychosis: Dimensional structure of symptoms, clinical subtypes and related neurodevelopmental markers. European Child & Adolescent Psychiatry, 27(2), 171–179. doi: 10.1007/s00787-017-1026-7CrossRefGoogle ScholarPubMed
Schimmelmann, B. G., Conus, P., Cotton, S., McGorry, P. D., & Lambert, M. (2007). Pre-treatment, baseline, and outcome differences between early-onset and adult-onset psychosis in an epidemiological cohort of 636 first-episode patients. Schizophrenia Research, 95(1-3), 1–8. doi: 10.1016/j.schres.2007.06.004CrossRefGoogle Scholar
Suen, Y. N., Wong, S. M. Y., Hui, C. L. M., Chan, S. K. W., Lee, E. H. M., Chang, W. C., & Chen, E. Y. H. (2019). Late-onset psychosis and very-late-onset-schizophrenia-like-psychosis: An updated systematic review. International Review of Psychiatry, 31(5-6), 523–542. doi: 10.1080/09540261.2019.1670624CrossRefGoogle Scholar
Thompson, A., Nelson, B., & Yung, A. (2011). Predictive validity of clinical variables in the “at risk” for psychosis population: International comparison with results from the North American Prodrome Longitudinal Study. Schizophrenia Research, 126(1-3), 51–57. doi: S0920-9964(10)01553-7 [pii]10.1016/j.schres.2010.09.024CrossRefGoogle ScholarPubMed
Velthorst, E., Nieman, D. H., Becker, H. E., van de Fliert, R., Dingemans, P. M., Klaassen, R., … Linszen, D. H. (2009). Baseline differences in clinical symptomatology between ultra high risk subjects with and without a transition to psychosis. Schizophrenia Research, 109(1-3), 60–65. doi: S0920-9964(09)00068-1 [pii]10.1016/j.schres.2009.02.002CrossRefGoogle ScholarPubMed
White, T., Ho, B. C., Ward, J., O'Leary, D., & Andreasen, N. C. (2006). Neuropsychological performance in first-episode adolescents with schizophrenia: A comparison with first-episode adults and adolescent control subjects. Biological Psychiatry, 60(5), 463–471. doi: 10.1016/j.biopsych.2006.01.002CrossRefGoogle ScholarPubMed
Yung, A. R., McGorry, P. D., McFarlane, C. A., Jackson, H. J., Patton, G. C., & Rakkar, A. (1996). Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin, 22(2), 283–303. doi: 10.1093/schbul/22.2.283CrossRefGoogle ScholarPubMed
Yung, A. R., Phillips, L. J., Yuen, H. P., & McGorry, P. D. (2004). Risk factors for psychosis in an ultra high-risk group: Psychopathology and clinical features. Schizophrenia Research, 67(2-3), 131–142. doi: doi:10.1016/S0920-9964(03)00192-0. S0920996403001920 [pii]CrossRefGoogle Scholar
Zhang, T., Li, H., Woodberry, K. A., Seidman, L. J., Chow, A., Xiao, Z., & Wang, J. (2015). Interaction of social role functioning and coping in people with recent-onset attenuated psychotic symptoms: A case study of three Chinese women at clinical high risk for psychosis. Neuropsychiatric Disease and Treatment, 11, 1647–1654. doi: 10.2147/NDT.S85654CrossRefGoogle ScholarPubMed
Zhang, T., Li, H., Woodberry, K. A., Seidman, L. J., Zheng, L., Li, H., … Wang, J. (2014). Prodromal psychosis detection in a counseling center population in China: An epidemiological and clinical study. Schizophrenia Research, 152(2-3), 391–399. doi: 10.1016/j.schres.2013.11.039CrossRefGoogle Scholar
Zhang, T. H., Li, H. J., Woodberry, K. A., Xu, L. H., Tang, Y. Y., Guo, Q., … Wang, J. J. (2017). Two-year follow-up of a Chinese sample at clinical high risk for psychosis: Timeline of symptoms, help-seeking and conversion. Epidemiology and Psychiatric Sciences, 26(3), 287–298. doi: 10.1017/S2045796016000184CrossRefGoogle ScholarPubMed
Zhang, T., Xu, L., Tang, Y., Cui, H., Tang, X., Wei, Y., … Wang, J. (2019 a). Relationship between duration of untreated prodromal symptoms and symptomatic and functional recovery. European Archives of Psychiatry and Clinical Neuroscience, 269(8), 871–877. doi: 10.1007/s00406-018-0917-z.CrossRefGoogle ScholarPubMed
Zhang, T., Xu, L., Tang, Y., Cui, H., Wei, Y., Wang, J., … Wang, J. (2018). Duration of untreated prodromal symptoms in a Chinese sample at a high risk for psychosis: Demographic, clinical, and outcome. Psychological Medicine, 48(8), 1274–1281. doi: 10.1017/S0033291717002707CrossRefGoogle Scholar
Zhang, T., Xu, L., Tang, Y., Li, H., Tang, X., Cui, H., … Group, S. S. (2019 b). Prediction of psychosis in prodrome: Development and validation of a simple, personalized risk calculator. Psychological Medicine, 49(12), 1990–1998. doi: 10.1017/S0033291718002738.CrossRefGoogle ScholarPubMed
Zhang, T., Yang, S., Xu, L., Tang, X., Wei, Y., Cui, H., … Wang, J. (2019 c). Poor functional recovery is better predicted than conversion in studies of outcomes of clinical high risk of psychosis: Insight from SHARP. Psychological Medicine. doi: 10.1017/S0033291719002174.Google ScholarPubMed
Zheng, L., Wang, J., Zhang, T., Li, H., Li, C., & Jiang, K. (2012). The Chinese version of the SIPS/SOPS: A pilot study of reliability and validity. Chinese Mental Health Journal, 26(8), 571–576.Google Scholar