Comparing illness presentation, treatment and functioning between patients with early- and adult-onset psychosis

Abstract

BACKGROUND: Early studies have shown that patients with early- and adult-onset schizophrenia differ in their illness presentation, psychopathology, pre-morbid traits and prognosis. Whether adult-onset schizophrenia represents a separate entity distinct from early-onset schizophrenia is yet uncertain. Therefore, the current study aimed at characterizing and contrasting adult-onset patients with an early-onset cohort in their basic demographics, illness presentation, treatment and functional level. METHODS: Participants were recruited from two territory-wide early intervention services for early-onset (n=671; from the Early Assessment Service for Young People with Psychosis Program, EASY) and late-onset psychosis patients (n=360; from the Jockey Club Early Psychosis Project, JCEP) in Hong Kong. Patients from the early-onset cohort had their initial psychotic episode during 2001 and 2003; data were then collected retrospectively by systematic case note review. The adult-onset cohort was prospectively recruited as part of a larger interventional study during 2009 and 2011; information was collected prospectively via face-to-face interviews with patients. RESULTS: At baseline, adult-onset psychosis (mean of 36.6 years old) was significantly associated with more females, more non-local birth, more full-time employment, better functioning level, fewer smokers, fewer with schizophrenia than early-onset psychosis (mean of 20.4 years old), better medication adherence and more psychiatric hospitalization. No significant group differences in duration of untreated psychosis were found. DISCUSSION: Managing psychotic illnesses optimally is an important challenge in health care delivery. The finding that adult-onset patients had better functioning challenges the view that early-onset psychosis and adult-onset psychosis share a similar prognostic trajectory. There is a need to adapt intervention processes, specifically for patients recovering from a first episode illness, in particular for early- and adult-onset, as they may face different unique sets of challenges.