Early onset psychotic disorders: diagnostic stability and clinical characteristics.

OBJECTIVES: To examine the clinical features and diagnostic stability of early-onset psychotic disorders. METHODS: These data are from a two-year longitudinal prospective study of youth with psychotic disorders. Standardized diagnostic assessments are administered at baseline and at one and two-year's follow-up. RESULTS: Fifty-one subjects have been recruited to date; 18 with schizophrenia, 14 with bipolar disorder, 7 with schizoaffective disorder, 1 with an organic psychosis, and 11 subjects whose symptoms where either questionable and/or did not meet diagnostic criteria for another disorder (classified as psychosis nos). Thirty-nine subjects were reassessed at year one, twenty-four at year two. Three subjects have been lost to follow-up. The study diagnosis was the same as the first onset diagnosis (prior to entering the study) in 50% of subjects. Over the two-year period of the study, the diagnosis remained unchanged in over 90% of subjects. Subjects with schizophrenia had higher ratings of premorbid impairment, including social withdrawal and dysfunctional peer relationships, than those with bipolar disorder. At the one-year follow-up, subjects with schizophrenia and schizoaffective disorder had significantly higher rates of delusions, bizarre behavior, and negative symptoms than those with bipolar disorder. Subjects with bipolar disorder tended to have cyclical courses, whereas those with schizophrenia and schizoaffective disorder were often chronically impaired. Subjects with psychosis nos had higher rates of dissociative symptoms and histories of child maltreatment. CONCLUSIONS: Early-onset psychotic disorders can be reliably diagnosed using standardized assessments and are stable over a two-year period. Compared to bipolar disorder, schizophrenia is associated with a poorer premorbid history, and persistent positive and negative symptoms.

Early-onset psychotic disorders: course and outcome over a 2-year period.

OBJECTIVE: To examine the course and outcome of early-onset psychotic disorders. METHOD: These are data from a longitudinal, prospective study of youths with psychotic disorders. Standardized diagnostic and symptom rating measures were used. RESULTS: Fifty-five subjects with the following disorders have been recruited: schizophrenia (n = 18), bipolar disorder (n = 15), psychosis not otherwise specified (n = 15), schizoaffective disorder (n = 6), and organic psychosis (n = 1). Follow-up assessments were obtained on 42 subjects at year 1 and 31 subjects at year 2. Youths with schizophrenia had more chronic global dysfunction, whereas subjects with bipolar disorder overall had better functioning, with a cyclical course of illness. However, according to results of a regression model, premorbid functioning and ratings of negative symptoms, but not diagnosis, significantly predicted the highest level of functioning over years 1 and 2. CONCLUSIONS: Course and level of functioning differentiated bipolar disorder from schizophrenia. However, premorbid functioning and ratings of negative symptoms were the best predictors of functioning over the follow-up period. These findings are consistent with the adult literature, and they further support that psychotic illnesses in young people are continuous with the adult-onset forms.

Sexual behavior associated with low Verbal IQ in youth who have severe mental illness.

A retrospective chart review was used to examine sexual behavior (hypersexual, exposing, and victimizing) and cognitive impairment in 200 youth who had serious mental illness. Lower IQ was associated with increased sexual acting-out. For more serious victimizing sexual behaviors, only Verbal IQ differences reached statistical significance. Overall, sexual behavior was strongly associated with a history of sexual abuse. Sexual abuse history was significantly associated only with lower Performance IQ. Therefore, the association between low Verbal IQ and sexual victimizing behavior is distinct from the effects of sexual abuse. Results underscore the importance of verbal cognitive abilities, regardless of overall cognitive level, in the etiology and treatment of sexual behaviors, especially among individuals without a history of sexual abuse.

Neurodevelopmental Pathways in Schizophrenia.

We examined early-onset schizophrenia as a neurodevelopmental disorder. These data are from a 2-year longitudinal prospective study of youth with psychotic disorders. Standardized diagnostic and neuropsychological assessments include: Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-IV; Diagnostic Interview for Children and Adolescents, Revised; Premorbid Adjustment Scale; Wechsler Intelligence Scale for Children-III; the Wisconsin Card Sorting Test (WCST), and the California Verbal Learning Test. Pertinent family and developmental history are obtained via parent interviews and chart review. Forty-eight subjects have been recruited to date; 17 with schizophrenia, 13 with bipolar disorder, 10 with psychosis nos, seven with schizoaffective disorder, and one with an organic psychosis. Subjects with schizophrenia had higher ratings of premorbid social withdrawal and dysfunctional peer relationships. All groups had high rates of cognitive impairment, prenatal/perinatal complications, and comorbid psychiatric disorders. Homotypic family psychiatric history was associated with diagnosis in youth. Our data are consistent with a neurodevelopmental model, whereby specific genetic/neurological risk factors and nonspecific biologic/environmental modulating factors interact in the development of schizophrenia and other psychotic disorders.

Relationship between sexual abuse, gender, and sexually inappropriate behaviors in seriously mentally ill youths.

OBJECTIVE: To examine gender differences in sexual abuse histories and in the development of inappropriate sexual behaviors in a sample of seriously mentally Ill youths. METHOD: A retrospective chart review was completed for all patients from 1987 through 1992 at a tertiary care public sector psychiatric hospital for youths (N = 499). Subjects were categorized by gender, sexual abuse status, and whether they had sexually reactive or victimizing behaviors. RESULTS: Girls were more likely to have been sexually abused, and their abuse histories were more severe. Sexual behavior problems in girls were almost exclusively associated with sexual abuse, whereas 29% of boys with victimizing behaviors had no sexual abuse history. Among sexually abused youths, boys were more likely to display victimizing behaviors, whereas both genders displayed similar rates of sexually reactive behaviors. Of the 19 girls who displayed victimizing behaviors, 95% were chronically sexually abused and one third had also received a major injury due to physical abuse. CONCLUSIONS: Boys appear to have a lower threshold of abuse exposure required to develop sexually inappropriate behaviors and are significantly more likely to display victimizing behaviors. Conversely, victimizing behaviors in girls may require a catastrophic maltreatment history. These gender differences should be incorporated into treatment interventions directed at sexual abuse victims.

Age of onset of sexual abuse: relationship to sexually inappropriate behaviors.

OBJECTIVE: To examine how the age of onset of sexual abuse predicted inappropriate sexual behaviors in a sample of seriously mentally ill youths. METHOD: A retrospective chart review was completed for all youths treated from 1987 through 1992 at a tertiary care public sector psychiatric hospital (n = 499). Subjects were grouped according to the age at which they were first sexually abused: no sexual abuse (n = 225), 0 through 3 years (n = 78), 4 through 6 years (n = 105), 7 through 12 years (n = 71), and 13 through 17 years (n = 19). RESULTS: The rates of sexually inappropriate behaviors in subjects with sexual abuse histories were quite substantial, ranging from 79.5% of the 0- through 3-year group to 42.1% of the 13- through 17-year group. Subjects first abused during early childhood, especially during the ages 0 through 3 years, had significantly elevated rates of hypersexual, exposing, and victimizing sexual behaviors. They also were significantly younger at the time of admission, came from more disrupted family settings, and had significantly higher rates of physical abuse, neglect, chronic sexual abuse, sexual abuse by either parent/stepparent and a higher total number of victimizers. When logistic regression analyses were done to examine the predictive power of potential risk factors, early age of onset of sexual abuse was the most significant predictor of all three types of inappropriate sexual behaviors. CONCLUSIONS: Onset of sexual abuse prior to 7 years of age was significantly associated with hypersexual, exposing, and victimizing sexual behaviors. Early sexual abuse is also associated with a number of other poor prognostic factors, and further research is needed to define how these variables interact.

Clinical characteristics related to severity of sexual abuse: a study of seriously mentally ill youth.

OBJECTIVE: In this study we examined demographic, social, and clinical variables related to sexual abuse histories in a sample of severely mentally ill youth. METHOD: Data were collected via a retrospective chart review of all patients treated over a 5-year period (1987-1992) at a tertiary care public sector psychiatric hospital. The sample was divided into four groups: no history of sexual abuse (n = 226); isolated events (n = 62); intermittent abuse (n = 61); and chronic (n = 150). RESULTS: Youth with sexual abuse histories were more often female, had higher rates of social chaos and associated physical abuse and neglect, and had higher rates of post-traumatic stress disorder (PTSD) and substance abuse disorders. Chronically abused subjects came from the most chaotic and abusive backgrounds; were younger when first abused; had the highest number of abusers; were more likely to have been molested; and were more often abused by their father/stepfather and/or their mother/stepmother. Using logistic regression analyses, sexual abuse histories were predicted by sexually inappropriate behaviors, symptoms of PTSD and borderline personality disorders, dissociative symptoms, substance abuse and animal cruelty. CONCLUSION: Sexual abuse histories were quite common in this sample. Sexually abused subjects had increased rates of inappropriate sexual behaviors, substance abuse, and post-traumatic reactions; and were frequently exposed to other confounding environmental risk factors, including physical abuse, family problems and social chaos.

Sexually inappropriate behaviors in seriously mentally ill children and adolescents.

This study examined the prevalence and clinical correlates of sexually inappropriate behaviors in all youth treated at a tertiary care public sector psychiatric hospital over a 5-year period. A retrospective chart review was completed on 499 subjects. Subjects were grouped in four mutually exclusive categories: no inappropriate sexual behaviors (n = 296), hypersexual (n = 82), exposing (n = 39) and victimizing (n = 82) behaviors. Those with histories of sexually inappropriate behaviors had much higher rates of being sexually abused (82 vs. 36%), and also had higher rates of physical abuse and neglect, behavior disorders, developmental problems, and family histories of antisocial behavior. They were less likely to have affective disorders. The hypersexual group had a higher proportion of females, and was associated in part with variables relating to sexual abuse and posttraumatic stress disorder. The more severe offending groups (exposing and victimizing) were associated with variables related to sexual abuse, developmental delays, lower IQ's, peer problems, and other acting-out behavior problems. These findings underscore the importance of evaluating for sexually inappropriate behaviors in seriously mentally ill youth, especially in those with histories of sexual abuse.

Prior stress and behaviorally conditioned histamine release.

Male guinea pigs were either handled ('stressed') or not disturbed ('non-stressed') for four weeks prior to conditioning with a classical discrimination conditioning design. Animals were sensitized to bovine serum albumin (BSA) and four weeks later presented with either an odor (the CS+) paired with BSA or a second odor (the CS-) paired with saline. These pairs were presented in a random order for ten trials. Weekly blood samples were assayed for histamine and cortisol levels. Following the conditioning trials, animals were subjected to extinction trials during which the CS+ odor was presented but not paired with the BSA. The animals handled prior to the conditioning procedures learned the association between the odor and the BSA as indicated by increased histamine levels when exposed to the conditioned odor alone. The non-handled group did not learn. Additionally, the cortisol levels were significantly higher for the handled group vs. the non-handled group when the CS+ was presented during extinction. The role of stress in both learning and immunomodulation is discussed.