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Age at the time of onset of psychosis: A marker of specific needs rather than a determinant of outcome?

Published online by Cambridge University Press:  23 March 2020

P. Golay ,
L. Alameda ,
N. Mebdouhi ,
P. Baumann ,
C. Ferrari ,
A. Solida ,
P. Progin ,
J. Elowe  and
P. Conus
P. Golay*
Affiliation:
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), 1003Lausanne, Switzerland Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), 1003Lausanne, Switzerland
L. Alameda
Affiliation:
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), 1003Lausanne, Switzerland Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Lausanne University Hospital (CHUV), 1008Lausanne, Switzerland Psychiatric Liaison Service, Lausanne University Hospital (CHUV), 1011Lausanne, Switzerland
N. Mebdouhi
Affiliation:
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), 1003Lausanne, Switzerland
P. Baumann
Affiliation:
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), 1003Lausanne, Switzerland Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Lausanne University Hospital (CHUV), 1008Lausanne, Switzerland
C. Ferrari
Affiliation:
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), 1003Lausanne, Switzerland
A. Solida
Affiliation:
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), 1003Lausanne, Switzerland
P. Progin
Affiliation:
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), 1003Lausanne, Switzerland
J. Elowe
Affiliation:
Mobile Psychiatry Unit, Department of Psychiatry, Prangins Psychiatric Hospital (CHUV), 1197Prangins, Switzerland
P. Conus
Affiliation:
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), 1003Lausanne, Switzerland
*
*Corresponding author. Department of Psychiatry, Lausanne University Hospital, consultations de Chauderon, 18, place Chauderon, 1003 Lausanne, Switzerland. Fax: +41 213 141 277. E-mail address:philippe.golay@chuv.ch (P. Golay).
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Abstract

Background:

While there is suggestion that early onset of psychosis is a determinant of outcome; knowledge regarding correlates of later onset age is more limited. This study explores the characteristics of patients developing psychosis after age 26, towards the end of the usual age range of early intervention programs, in order to identify potential specific needs of such patients.

Methods:

Two hundred and fifty-six early psychosis patients aged 18–35 were followed-up prospectively over 36 months. Patients with onset after 26 (“later onset”, LO) were compared to the rest of the sample.

Results:

LO patients (32% of the sample) had shorter DUP, were less likely to be male, had better premorbid functioning and were more likely to have been exposed to trauma. They had greater insight at presentation and less negative symptoms overall. The trajectories for positive and depressive symptoms were similar in both groups. Evolution of functional level was similar in both groups, but while LO patients recovered faster, they were significantly less likely to return to premorbid functional level.

Conclusions:

Later psychosis onset correlates with better premorbid functioning and higher rate of trauma exposure; the latter should therefore be a treatment focus in such patients. LO patients were less likely to return to premorbid functional level, which suggests that current treatment strategies may not be efficient to help patients maintain employment. The possibility of distinct illness mechanisms according to onset age and the more central role for trauma in patients with onset after age 26 needs to be further explored.

Keywords

Age of onsetEarly psychosisEarly interventionTrauma
Type
Original article
Information
European Psychiatry , Volume 45 , September 2017 , pp. 20 - 26
Copyright
Copyright © European Psychiatric Association 2017

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