Articles
Adult Outcome of Social Function in Adolescent-Onset Schizophrenia and Affective Psychosis

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ABSTRACT

Objective

To examine and compare the adult outcome in a representative sample of hospitalized adolescent-onset psychoses including occupational and social aspects.

Method

A total of 81 patients with a first episode of early-onset psychosis (before age 19 years) presenting to the University Hospital of Lund, Sweden, between 1982 and 1993 were followed up an average of 10.5 years (range 5.1–18.2) after admission. Initial diagnosis was assessed from records and consisted of DSM-IV schizophrenia (n = 32), schizoaffective disorder (n = 7), bipolar disorder (n = 25), and major depressive disorder with psychotic features (n = 17). All could be traced and assigned a major outcome group.

Results

Early-onset schizophrenia spectrum disorder suffered a chronic course with a poor outcome in 79% of the cases, while early-onset affective psychosis in 74% showed a good or intermediate outcome. The poor outcome (26%) in the affective group was connected to mental retardation in 7% and to progression to a schizoaffective disorder in 12%. A particularly severe outcome was seen for schizophrenia spectrum patients with a family history of nonaffective psychosis.

Conclusions

Early-onset schizophrenia spectrum disorder showed a severe course while affective psychoses had a much more benign functional outcome.

Section snippets

Subjects

All patients admitted to the inpatient unit at the Department of Child and Adolescent Psychiatry, University Hospital of Lund, Sweden, between 1982 and 1993 with a first episode of a psychotic disorder were included in the study. All hospitalizations were checked in the registers. Cases with a facility diagnosis of a psychotic disorder, depression, personality disorder, or any inpatient stay of more than 2 months were reviewed according to DSM-IV criteria. All patients (n = 88) with a DSM-IV

Descriptive Characteristics of the Sample

Pertinent background and first-episode data are reported in Table 1. The first psychotic symptom emerged at age 15.6 (SD 1.5) years, and the 78 subjects in the followed-up sample excluding the three suicides were followed up 10.5 (SD 3.6) years later at age 26.3 (SD 3.6) years. Social class of parents according to the Swedish Bureau of Statistics was 26% professionals, 46% skilled workers, and 28% unskilled workers. Most patients (94%) were white. There were not any differences in ethnicity,

DISCUSSION

The functional outcome of adolescent-onset schizophrenia and schizoaffective disorder was significantly and considerably worse across all major measures compared with the outcomes of the affective psychoses.

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    From the Department of Child and Adolescent Psychiatry, University Hospital, Uppsala, Sweden (Drs. Jarbin and von Knorring), and the Department of Child and Adolescent Psychiatry, University Hospital, Lund, Sweden (Dr. Ott).

    This study was supported by a grant from the Gadelius Foundation and from the University Hospital of Lund. The authors are indebted to Hans Eriksson, M.D., and Associate Professor Katarina Nyman, M.D., for assessing records.

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