Early-onset psychosis: What is the diagnostic outcome?

Abstract

Background and objectives: Schizophrenia and bipolar disorder may show overlapping symptom profiles especially in early-onset cases. The aim of this study was to establish a final diagnosis, examine possible similarities and differences in symptom presentations, and overall functioning of patients with early-onset psychotic episode. Methods: Adolescents, presenting with at least one psychotic symptom, who were clinically followed up for at least 6 months, constituted our sample. Psychiatric diagnoses were established by using Schedule for Affective Disorders and Schizophrenia for School Aged Children Present-Lifetime Version (K-SADS-PL), psychotic symptoms were assessed by Positive and Negative Syndrome Scale (PANSS), and level of functioning was determined by Children's Global Assessment Scale (CGAS). Results: Of 51 patients, 55% received a diagnosis of Psychotic Disorder (PD) and 45% a Mood Disorder (MD). Besides a major overlap in symptom presentation, there were significant differences in distribution. Hallucinations, disorganized speech, and withdrawal/isolation were encountered significantly more in the PD group, whereas hyperactivity, increased speech, and aggression were significantly more frequent in the MD group. PANSS positive, negative, and general psychopathology scores were significantly higher in the PD group. The difference was more pronounced in terms of PANSS negative scores. Overall functioning was similar in two groups. Conclusions: Adolescents with early-onset psychotic episodes present with a combination of psychotic and mood related symptoms. Initial assessments may have the risk of misdiagnosis. During follow-up, clinicians should not underestimate the possibility of a mood disorder with psychotic features, whereas negative psychotic symptoms may have a discriminative value in favor of psychotic disorders. (C) 2018 Asociacion Universitaria de Zaragoza para el Progreso de la Psiquiatria y la Salud Mental. Published by Elsevier Espana, S.L.U. All rights reserved.