Early detection and optimal treatment may improve outcome in early-onset schizophrenia: Evidence from the EPPIC medium-term follow-up study of first episode psychosis

Previous research has suggested that poor outcome is typical in early-onset schizophrenia (EOS) which manifests before the age of 18 years. However, no study to date has compared the medium-term outcome of EOS vs. adult-onset schizophrenia (AOS) attending the same, specialized treatment program. The purpose of this analysis is to examine the medium-term clinical and functional outcome of EOS vs. AOS within the Early Psychosis Prevention and Intervention Centre (EPPIC) medium-term follow-up study of first episode psychosis. This is a naturalistic, prospective follow-up of a large epidemiologically representative sample of 765 first-episode psychosis patients, followed up on average 7.4-years after initial presentation to a specialist early psychosis service (EPPIC) in Melbourne, Australia. Standardised assessments were used at the follow-up to assess participants’ demographic characteristics, axis I diagnosis, psychopathology and level of work and social functioning. Follow-up interviews were conducted on 511 participants; 133 refused; 39 were deceased and 82 were un-contactable. No participant bias due to study attrition was found. This study focuses on the 290 individuals diagnosed at baseline with schizophrenia-spectrum disorders. Independent samples t-tests were used to compare EOS and AOS groups on psychopathology and outcome measures at medium-term followup. Statistical tests were two-tailed. P values of 0.05 or less were considered statistically significant. EOS was found in 31 (10.7%), AOS in 259 (89.3%) of individuals in the sample. T-tests indicated no significant group differences on BPRS total, BPRS psychotic subscale, SANS total, and SOFAS mean scores. In contrast to an expected poorer outcome, individuals with EOS were characterized by significantly better functioning (GAF and SOFAS) and higher quality of life (QLS) at 7.4 year follow-up as compared to individuals with AOS. The present findings emphasize a much more optimistic view on the medium-term outcome of EOS which may be related to early detection and the specialized treatment program provided by EPPIC. These results also suggest that younger patients might stand to profit more from the treatment approach offered by such a service, particularly in terms of enhancement of their functioning and quality of life several years subsequent to treatment entry