Heiner Meng

Pretreatment social functioning predicts 1-year outcome in early onset psychosis

Objective:  The aim was to investigate the association of pretreatment social functioning (12 months before initial presentation) with symptom dimensions and social functioning at 1‐year follow‐up.

Patterns and Correlates of Expressed Emotion, Perceived Criticism, and Rearing Style in First Admitted Early-Onset Schizophrenia Spectrum Disorders

Abstract The aim of this study was to assess patterns and correlates of family variables in 31 adolescents treated for their first episode of a schizophrenia spectrum disorder (early-onset schizophrenia [EOS]). Expressed emotion, perceived criticism, and rearing style were assessed. Potential correlates were patient psychopathology, premorbid adjustment, illness duration, quality of life (QoL), sociodemographic variables, patient and caregiver “illness concept,” and caregiver personality traits and support. Families were rated as critical more frequently by patients than raters (55% vs. 13%). Perceived criticism was associated with worse QoL in relationship with parents and peers. An adverse rearing style was associated with a negative illness concept in patients, particularly with less trust in their physician. Future research should examine perceived criticism as a predictor of relapse and indicator of adolescents with EOS who need extended support and treatment. Rearing style should be carefully observed because of its link with patients’ illness concept and, potentially, to service engagement and medication adherence.

Specificity of basic symptoms in early onset schizophrenia

Developmental psychopathology addresses several important questions of the pathogenesis of psychotic disorders proposing a conceptual framework, which includes developmental psychology, neurobiology and clinical psychopathology. The first question to be raised is the contribution of normal developmental processes to the pathogenesis of psychotic symptoms, ending up with the second question, what impacts psychopathology itself may exert on normal development concerning defects, vulnerabilities and disturbances of age-dependent adaptive processes [11]. Normal cognitive and emotional development seems to be a prerequisite for symptom formation. These assumptions may help us in the interpretation of different psychotic and prodromal phenomena in children and adolescents. Looking at the table of ages, we find overlapping disturbances in various age groups. First manifestations of pervasive developmental disorders - Kanner-Autism [7] - can be detected in the age group from birth to six years. Asperger syndrome [2] may be particularly detected in the age group between six and nine years. In this age group also very early onset psychosis can be elucidated, which shows predominantly formal thought disorder and inappropriate affect. Very early onset psychoses presenting with hallucinations and delusions rather seem to start off in the age group between nine and twelve years. Of these patients, 60% show developmental disorders of speech and language, and about one third present with pervasive developmental disorders in prodromal stages [1]. Early onset psychoses with a lifetime prevalence of about 0.23% begin in the age group between twelve and eighteen [3]. Adult psychosis presents with prodromal features that reach back into ages around and before puberty [5]. From an epidemiological point of view all these groups of disorders may be found during the adolescent age.