A prognostic study of clinical dimensions in adolescent-onset psychoses

Adolescent-onset psychoses often raise diagnostic difficulties because of t he mixture of schizophrenic and affective features. This study examined pro spectively which clinical dimensions contribute to difficulty in initial di agnosis and which clinical features have predictive value for outcomes of s chizophrenia or affective disorders, and for eventual psychosocial function ing. Thirty-six adolescents consecutively admitted for a psychotic episode were followed up for 1 to 4 years. Symptoms were assessed at admission, at discharge, and once a year. DSM-III-R (APA 1989) diagnoses were assessed at admission and once a year. Comparisons were performed across initial and f ollowup diagnostic groups. Positive symptoms did not differentiate the init ial clinical pictures, while negative symptoms, manic symptoms, and disorga nization differentiated the manic and depressive episodes in the acute phas e. When initial positive symptoms (mainly delusions) were severe, they pred icted a final diagnosis in the schizophrenia spectrum. Poor outcome was ass ociated with more anhedonia-asociality and lower functioning scores at admi ssion. Results suggest (1) a higher vulnerability to positive symptoms in a dolescents who will further develop schizophrenia and (2) the low specifici ty of affective symptoms at this age.