To review the characteristics of all patients presenting with a first episode of psychosis between the ages of 16 and 65 years to an adult area mental health service.
Methods:
The early psychosis programme at St Vincent’s Hospital Melbourne treats all patients presenting in the early stages of psychosis between the ages of 16 and 65 years. A database was developed to capture the demographic and diagnostic characteristics of the group. The characteristics of those with an onset under 26 years were compared with those with a later onset.
Results:
A large proportion (55%) of those presenting with first episode psychosis presented after the age of 25 years. There were a higher number of cases of depression with psychotic features in the older onset patients (notably so for those over 40) and a trend towards greater metabolic morbidity.
Discussion:
Older patients presenting with a first episode of psychosis are relatively understudied but appear to have certain distinguishing qualities. Understanding the needs of these patients is important in tailoring optimal treatment packages and service responses.
BerriosGELuqueRVillagránJM. Schizophrenia: a conceptual history. Internat J Psych Psych Therapy2003; 3: 111–140.
2.
CastleDBuckleyP. Diagnosis and classification. In: CastleDJBuckleyP (eds) Schiophrenia. Oxford: Oxford University Press, 2011.
3.
NayakGFolsomDTwamleyE. Treatment of late-life schizophrenia. In: TonmoySHarveyPD (eds) The early course of schizophrenia. Oxford: Oxford University Press, 2006, pp. 225–236.
4.
HowardRRabinsPVSeemanMV. The international late-onset schizophrenia group, late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. Amer J Psych2000; 157: 172–178.
5.
RothMKayD. Late paraphrenia: a variant of schizophrenia manifest in late life or an organic clinical syndrome? A review of recent evidence. Internat J Geriatric Psych1998; 13: 775–84.
6.
CastleDMurrayR. The epidemiology of late-onset schizophrenia. Schizophr Bull1993; 19: 691–700.
7.
JesteDHarrisMKrullA. Clinical and neuropsychological characteristics of patients with late-onset schizophrenia. Amer J Psych1995; 152: 722–730.
8.
American Psychiatric Association. DSM-III: diagnostic and statistical manual of mental disorders. 3rd ed.Washington, DC: American Psychiatric Association, 1980.
9.
American Psychiatric Association. DSM-III-R: Diagnostic and statistical manual of mental disorders. 3rd ed., revised. Washington, DC: American Psychiatric Association, 1987.
10.
ReevesRBristerJ. Psychosis in late life: emerging issues. J Psych Nursing2008; 46: 45–52.
11.
KrishnanKHaysJTuplerL. Clinical and phenomenological comparisons of late-onset and early-onset depression. Amer J Psych1995; 152: 785–788.
12.
SchürhoffabFBellivierbcFJouventaR. Early and late onset bipolar disorders: two different forms of manic-depressive illness?J Affective Disord2000; 58: 215–221.
13.
McGorryPKillackeyEYungA. Early intervention in psychotic disorders: detection and treatment of the first episode and the critical early stages. Med J Aust2007; 187: S8–S10.
14.
YungARYuenHPBergerG. Declining transition rate in ultra high risk (prodromal) services: dilution or reduction of risk?Schizophr Bull2007; 33: 673–681.
15.
McGorryPYungA. Early intervention in psychosis: an overdue reform: an introduction to the early psychosis symposium. Aust New Zeal J Psych2003; 37: 393–398.
16.
National Early Psychosis Project Clinical Guidelines Working Party. The Australian clinical guidelines for early psychosis National Early Psychosis Project. University of Melbourne, Australia, 1998.
17.
StephensCCastleDSelvendraA. St Vincent’s clinical guidelines for early psychosis. St Vincent’s Hospital Melbourne, Australia, 2006.
18.
ChopraPHamiltonBCastleD. Implementation of the strengths model at an area mental health service. Aust Psych2009; 17: 202–6.
19.
PetrakisMPennoSOxleyJ. Early psychosis treatment in an integrated model within an adult mental health service. Euro Psych2012; 27: 483–488.
20.
AddingtonJAmmingerGBarbatoA. International clinical practice guidelines for early psychosis. Brit J Psych2005; 187: S120–S124.
21.
Early Psychosis Guidelines Writing Group. Australian clinical guidelines for early psychosis. 2nd ed.Orygen Youth Health, Melbourne, Australia, 2010.
22.
HarveyP. Late-onset schizophrenia: characteristics of patients at the first episode. In: TonmoySHarveyPD (eds) The early course of schizophrenia. Oxford: Oxford University Press, 2006, pp. 174–185.
23.
CastleDMcGrathJ. Women and schizophrenia: an epidemiological perspective. In: CastleDMcGrathJKulkarniJ (eds) Women and schizophrenia. Cambridge: Cambridge University Press, 2000.
24.
HarrisMJesteD. Late-onset schizophrenia: an overview. Schizophr Bull1988; 14: 39–45.
25.
ThorupAWaltoftBLPedersenCB. Young males have a higher risk of developing schizophrenia: a Danish register study. Psych Med2007; 37: 479–484.
26.
SaxKStrakowskiSKeckJP. Comparison of patients with early-, typical-, and late-onset affective psychosis. Amer J Psych1997; 154: 1299–1301.
27.
ParkerGManicavasagarV. Modelling and managing the depressive disorders. A clinicial guide. Cambridge: Cambridge University Press, 2005, pp. 42–50.
28.
HäfnerH. Gender differences in schizophrenia. Psychoneuroendocrinology2003; 28: 17–54.
29.
KulkarniJHayesEGavrilidisE. Hormones and schizophrenia. Curr Op Psych2012; 25: 89–95.
30.
KimJBaekJChoiJ. Diagnostic stability of first-episode psychosis and predictors of diagnostic shift from non-affective psychosis to bipolar disorder: a retrospective evaluation after recurrence. Psych Res2011; 188: 29–33.
31.
AddingtonJChavesAAddingtonD. Diagnostic stability over one year in first-episode psychosis. Schizophr Res2006; 86: 71–75.
32.
Australian Bureau of Statistics.Australian health survey: updated results, 2011–12. 7June2013 ed. Canberra, Australia, 2013.
33.
EriksonEH. Identity and the life cycle. New York: WW Norton and Company, 1994.
