Age and early symptoms of a psychotic disorder

Early detection in patients with psychotic disorders is crucial to be able to diagnose, treat, and improve their prognosis. A recent study reveals that the patient’s age is a more important factor than previously believed, and if not properly taken into account, making the exact diagnosis can be very difficult.

The results of this study underline that the clinical manifestations, depending on the age of the patient, can be confusing and delay treatment. This period of time is also influenced by the type of symptoms of the patient, so the early detection approach must take these aspects into account in order to improve the future quality of life of people with a psychotic disorder.

The study has been led by the Mental Health Network Biomedical Research Center (CIBERSAM) in Spain, with the participation of various work groups integrated into the center, and the Hospital Clínic of Barcelona.

Regarding age, another of the research advances is the fact that it has been observed that patients under 18 years of age take longer to start treatment for psychotic disorders than adults. Regarding the prodromal symptoms (the first to appear), some of those presented by patients who end up having bipolar disorder one year after the first psychotic episode, may have a different profile than those who will have schizophrenia.

The objective of the research was to compare the prodromal symptomatology and the duration of untreated psychosis (DUP) of patients with a first psychotic episode, according to the age of onset (early or in adulthood), and the diagnosis at one year ( schizophrenia or bipolar disorder), using a structured scale: the Symptom Onset in Schizophrenia (SOS).

The investigation included 331 patients, of which 58 were minors, and in it, it was observed that minors had a duration of untreated psychosis (DUP), significantly longer than adults, and a higher frequency of some prodromal symptoms, such as hallucinations and problems with thinking.

On the other hand, as explained by Inmaculada Baeza, a researcher at CIBERSAM and the Hospital Clínic de Barcelona, ​​and who heads the team that carried out the study: “those patients with schizophrenia presented higher untreated psychosis than those who manifested bipolar disorder , and a different prodromal (onset) symptom profile. On the one hand, dysphoria, sadness, anxiety or irritability, and sleep problems were more frequent in bipolar patients; and hallucinations, delusions, social isolation and diminished experience of emotions in those diagnosed with schizophrenia”.

From left to right: Elena de la Serna, Inmaculada Baeza, Josefina Castro-Fornieles and Olga Puig, from the research team. (Photo: CIBER / Carlos III Health Institute (ISCIII) / Hospital Clínic de Barcelona)

In summary, the results of this study indicate several important points at the clinical level, which have to do with the age of the patients, and the type of symptoms at the beginning of the first stage (prodromal) of a psychotic disorder.

For all these reasons, this research shows us that we must be extremely attentive to the symptoms presented by patients, in order to specify their diagnosis as soon as possible, and therefore, the most appropriate treatment for their pathology.

The study, derived from the Psychotic First Episodes Project (PEPs), is titled “Prodromal symptoms and the duration of untreated psychosis in the first episode of psychosis patients: what differences are there between early vs. adult onset and between schizophrenia vs. bipolar disorder? It has been published in the academic journal European Child and Adolescent Psychiatry. And it has had the participation of 16 Spanish centers; In addition, many of the groups belong to the Mental Health Network Biomedical Research Center (CIBERSAM), led by Baeza. (Source: CIBER / Carlos III Health Institute (ISCIII))