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Marked neurocognitive deficits apparent in early-onset psychotic disorders.

BARCELONA -- Although their symptoms appear to improve within the first 2 years of diagnosis, girls and boys with early-onset psychoses show significant delays in neurocognitive development, and boys also exhibit changes in brain volume over the same period.

'At baseline, the boys in our sample already had decreased gray-matter volume and increased cerebrospinal fluid, compared to healthy controls," Dr. Carmen Moreno said at the annual congress of the European College of Neuropsychopharmacology

Those differences not only persisted but also accelerated over the 2 years that she and her colleagues followed the group.

Dr. Moreno, who is affiliated with the Hospital General Universitario Gregorio Maranon, Madrid, has studied several groups of adolescents with early-onset psychotic disorders. These patients face a challenging life, since early-onset psychoses generally are more severe and disabling than those beginning in adulthood, Dr. Moreno said.

"The disorders usually have an insidious onset, and there is much symptomatic overlap between the different diagnoses." They also start during a crucial period of life, causing many youngsters to "get off track" with their neurocognitive development during early adolescence.

Interestingly, children usually show some improvements in symptoms, especially in the first year after a diagnosis, Dr. Moreno said. Her recent study of 24 children with a first psychotic episode showed almost universal improvement in both positive and negative symptoms, as well as social disability and global functioning over 2 years (Child Psychiatry Hum. Dev-el. 2008;39:137-45).

"There was a marked improvement in all of Positive and Negative Syndrome Scale (PANSS) domains, most of which took place during the first year," she said.

But neurocognitive outcomes were not as positive. Another analysis of the 24 patients and 29 controls found that significant differences already existed between the groups at baseline.

Patients had lower scores in attention, working memory, executive function, and learning and memory

These differences were even greater at the 2-year assessment, Dr. Moreno

said. "We saw that the controls had improved in attention and executive functioning, as would be expected during this period of development," she noted.

And while the psychotic patients also had some improvement, their gains were not significant, compared with those of controls (Eur. Psychiatry 2008;23:375-83).

Unpublished data of another comparison of the group found that patients also had significantly more neurological soft signs, both at diagnosis and 2-year follow-up.

On the Neurological Evaluation Scale, patients scored a mean of 23 at baseline, compared with a score of 12 in controls.

At the 2-year assessment, patients had a mean score of 19, still significantly higher than controls' mean score of 9.

Taken together. Dr. Moreno said, "Our findings support a neurodevelopmental pathological process in early-onset psychosis with additional brain changes taking place during the first years after illness onset, she said.

According to Dr. Moreno, a longer, 5-year follow-up study is underway to help clarify the direction those changes over time.


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Author:Sullivan, Michele G.
Publication:Clinical Psychiatry News
Date:Oct 1, 2008
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