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Schizophrenia Bulletin 2000 26(4):789-799;
© 2000 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
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© Oxford University Press

A Prognostic Study of Clinical Dimensions in Adolescent-Onset Psychoses

Marie-Laure Paillère-Martinot, M.D., Ph.D., François Aubin, M.D., Jean-Luc Martinot, M.D., Ph.D., Psychiatrist, Director of Research and Bertrand Colin, M.D., Consulting Psychiatrist
Psychiatrist, Hôpital de la Salpêtrière, Assistance Publique-Hôpitaux de Paris Paris, France, and INSERM Unité 334, Service Hospitalier Frédéric Joliot, CEA Orsay, France
Head of Biometry, Laboratoires Fournier Garches, France, and Consulting Psychiatrist, SHU, Hôpital Sainte-Anne Paris, France
INSERM Unité 334, Service Hospitalier Frédéric Joliot, CEA
Child and Adolescent Psychiatry Department, Hôpital de la Salpêtrière, Assistance Publique-Hôpitaux de Paris

Send reprint requests to Dr. M.-L. Paillère-Martinot, Service de Psychiatrie Adultes, Hôpital de la Salpêtrière, 47 Boulevard de l'Hôpital, 75651, Paris cedex 13, France; e-mail: ml.paillere{at}psl.ap-hop-paris.fr

Adolescent-onset psychoses often raise diagnostic difficulties because of the mixture of schizophrenic and affective features. This study examined prospectively which clinical dimensions contribute to difficulty in initial diagnosis and which clinical features have predictive value for outcomes of schizophrenia or affective disorders, and for eventual psychosocial functioning. 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 followup diagnostic groups. Positive symptoms did not differentiate the initial clinical pictures, while negative symptoms, manic symptoms, and disorganization differentiated the manic and depressive episodes in the acute phase. When initial positive symptoms (mainly delusions) were severe, they predicted a final diagnosis in the schizophrenia spectrum. Poor outcome was associated with more anhedonia-asociality and lower functioning scores at admission. Results suggest (1) a higher vulnerability to positive symptoms in adolescents who will further develop schizophrenia and (2) the low specificity of affective symptoms at this age.

Keywords: Adolescence / psychotic episodes / clinical dimensions / outcome / diagnosis / schizophrenia / bipolar disorders


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