Predictors of Functional and Clinical Outcome in Early-Onset First-Episode Psychosis: The Child and Adolescent First Episode of Psychosis (CAFEPS) Study

被引:18
作者
Parellada, Mara [1 ]
Castro-Fornieles, Josefina [2 ]
Gonzalez-Pinto, Ana [3 ]
Pina-Camacho, Laura [1 ,4 ]
Moreno, Dolores [1 ]
Rapado-Castro, Marta [1 ]
Otero, Soraya [5 ]
de la Serna, Elena [6 ]
Moreno, Carmen [1 ]
Baeza, Inmaculada [2 ]
Graell, Montserrat [7 ]
Arango, Celso [1 ]
机构
[1] Univ Complutense, Hosp Gen Univ Gregorio Maranon, Child & Adolescent Psychiat Dept, Sch Med,IiSGM,CIBERSAM, Madrid 28009, Spain
[2] Hosp Clin Barcelona, Dept Child & Adolescent Psychiat & Psychol, Barcelona, Spain
[3] Univ Basque Country, Santiago Apostol Hosp, Biomed Res Ctr Mental Hlth Net, Vitoria, Spain
[4] Kings Coll London, Inst Psychiat, Dept Child & Adolescent Psychiat, London WC2R 2LS, England
[5] Hosp Univ Marques de Valdecilla, Dept Psychiat & Psychol, Child & Adolescent Mental Hlth Unit, Santander, Spain
[6] CIBERSAM, Ctr Invest Biomed Red Salud Mental, Barcelona, Spain
[7] Hosp Infantil Univ Nino Jesus, Sect Child & Adolescent Psychiat & Psychol, Madrid, Spain
关键词
Child and Adolescent Psychiatry; Psychotic Disorders; Schizophrenia; Diagnosis/Diagnostic Tools; FOLLOW-UP; PREMORBID ADJUSTMENT; AFFECTIVE-DISORDERS; NEGATIVE SYMPTOMS; BASE-LINE; SCHIZOPHRENIA; ASSOCIATION; REMISSION; INSIGHT; STABILITY;
D O I
10.4088/JCP.13m08863
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Objective: The objective of this study was to study baseline clinical and biological predictors of 2-year outcome in a cohort of children and adolescents with a first episode of psychosis. Method: Standard instruments were used to evaluate symptoms and functioning in 110 children and adolescents (mean age = 15.47 years) with first episode of psychosis at admission (between 2003 and 2005) and after 2-year follow-up. Clinical assessments included diagnostic assessment to yield DSM-IV diagnosis, developmental, premorbid, and past-year data, together with structural neuroimaging and other biological parameters (genetics and oxidative stress). Eighty-three subjects had assessments at baseline (including the Strauss-Carpenter Outcome Scale [SCOS]) and at 2-year follow-up. Association and multistep regression analyses were conducted to show correlates and predictors of primary outcome measures: functional outcome (Children's Global Assessment Scale [CGAS]), improvement (CGAS change), and primary negative symptoms (Proxy for the Deficit Syndrome Scale). Results: The SCOS predicted 27.46% (P < .001) of the variance in CGAS score at 2 years. Baseline severity (measured by CGAS) predicted 30.9% (P < .001) of CGAS improvement after 2 years, and SCOS total score predicted an added 24.1% (P < .001). A diagnosis of nonaffective psychosis, primary negative symptoms, and less white matter at baseline predicted more primary negative symptoms at follow-up. The prediction of functional outcome was not increased by genetic, oxidative stress, or neurostructural markers. Conclusions: Baseline clinical assessments have a better predictive value than biological assessments for 2-year follow-up functioning of children and adolescents with a first episode of psychosis. Patients with primary negative symptoms at baseline continue to have negative symptoms 2 years later, and neurostructural markers predict these. Clinicians must still rely on clinical variables to judge the functional prognosis of early-onset first psychotic episodes. (C) Copyright 2015 Physicians Postgraduate Press, Inc.
引用
收藏
页码:E1441 / +
页数:11
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