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 cerebrospinal fluid (CSF)
Clear, colourless liquid that surrounds the brain and spinal cord and fills the spaces in them. It helps support the brain, acts as a lubricant, maintains pressure in the skull, and cushions shocks. , 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 child psychiatry
Branch of medicine concerned with mental, emotional, and behavioral disorders of childhood. It arose as a separate field in the 1920s, largely because of the pioneering work of Anna Freud. Hum. Dev-el. 2008;39:137-45).
"There was a marked improvement in all of Positive and Negative Syndrome Scale (PANSS PANSS Positive & Negative Symptom Scale, see there ) 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 In neuropsychology and cognitive psychology, executive functioning is the mental capacity to control and purposefully apply one's own mental skills. Different executive functions may include: the ability to sustain or flexibly redirect attention, the inhibition of inappropriate , 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 Noun 1. pathological process - an organic process occurring as a consequence of disease
feminisation, feminization - the process of becoming feminized; the development of female characteristics (loss of facial hair or breast enlargement) in early-onset psychosis with additional brain changes taking place during the first years after illness onset, she said.
According to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. Dr. Moreno, a longer, 5-year follow-up study is underway to help clarify the direction those changes over time.
BY MICHELE G. SULLIVAN