Negative symptoms tied to declining prepsychosis social support

Adolescents experiencing negative symptoms prior to first psychotic episode were more likely to have declining social support prior to hospitalization, compared with adolescents who exhibited manic prodromal symptoms.

Indeed, "these results provide initial information on the identification of adolescents at highest risk for experiencing a decline in social support, who therefore may particularly benefit from focused intervention," J. E. DeVylder and R.E, Gearing reported in the journal Psychiatry Research.

Mr. DeVylder, a doctoral candidate at the Columbia University School of Social Work, New York, and Dr. Gearing, also of Columbia, looked at archival data from hospital records of inpatient psychiatric units in Ontario, Canada.

Patients were included if they were younger than 18 years of age at the time of hospital admission, hospitalized for a first episode of a primary psychotic disorder (nonaffective or affective), and discharged between Jan. 1, 1999 and Oct. 31, 2003. About one-third of the participants were born in a foreign country.

Nonfamilial social support was judged to be either declining, stable, or improving during the period prior to hospitalization, based on clinician judgment of peer relationships as well as social support and peer relations information from the patients, hospital staff, and collateral contacts, the authors wrote (Psychiatry Res. 2013 Feb. 28 [doi:10.1016/j.psychres.2013.02.004]).

"Only declining and stable were included in this study as no respondents endorsed an increased number of peer relationships," they added.

A total of 84 patients completed mail-in surveys and had all available information on record relating to social networks prior to hospitalization. Among these, the mean age was 14.7 years, 42.9% were female, and the mean duration of untreated psychosis was 19.7 weeks.

A total of 38 patients were deemed to have stable social networks, while the remaining 46 reported declining networks prior to hospitalization.

The authors reported that patients with declining social support had a significantly longer duration of untreated psychosis (25.4 weeks), compared with patients who had stable support systems (12.6 weeks; P less than .05).

Mr. DeVylder and Dr. Gearing also found that patients who reported declining social support were more likely to experience primarily negative symptoms during this prodromal period and less likely to experience manic symptoms.

"No association was found between gender and social support in this study, in contrast to prior findings [Psychol. Med. 2012;42;769-80] in a larger sample predominantly of adults (mean age 32 years) that males have more severe social disability at first episode of psychosis," the investigators added.

Nor was the presence of depression prior to hospitalization associated with social networks.

The study was hampered by its retrospective design, since it did not "allow us to examine specifically whether the decline in social support occurred following psychosis onset or during the prodromal phase, which has been associated with social impairment, or to determine causality in the associations between symptom profile and social support," the researchers conceded.

Nevertheless, "future studies should further examine the trajectory of change in the early course of psychosis with regards to social support as well as other clinical symptoms, either with adolescents at clinical high risk for psychosis or those in the early stages of overt symptoms."

Mr. DeVylder and Dr. Gearing disclosed no conflicts of interest and no outside funding.

Adolescents experiencing negative symptoms prior to first psychotic episode were more likely to have declining social support prior to hospitalization, compared with adolescents who exhibited manic prodromal symptoms.

Indeed, "these results provide initial information on the identification of adolescents at highest risk for experiencing a decline in social support, who therefore may particularly benefit from focused intervention," J. E. DeVylder and R.E, Gearing reported in the journal Psychiatry Research.

Mr. DeVylder, a doctoral candidate at the Columbia University School of Social Work, New York, and Dr. Gearing, also of Columbia, looked at archival data from hospital records of inpatient psychiatric units in Ontario, Canada.

Patients were included if they were younger than 18 years of age at the time of hospital admission, hospitalized for a first episode of a primary psychotic disorder (nonaffective or affective), and discharged between Jan. 1, 1999 and Oct. 31, 2003. About one-third of the participants were born in a foreign country.

Nonfamilial social support was judged to be either declining, stable, or improving during the period prior to hospitalization, based on clinician judgment of peer relationships as well as social support and peer relations information from the patients, hospital staff, and collateral contacts, the authors wrote (Psychiatry Res. 2013 Feb. 28 [doi:10.1016/j.psychres.2013.02.004]).

"Only declining and stable were included in this study as no respondents endorsed an increased number of peer relationships," they added.

A total of 84 patients completed mail-in surveys and had all available information on record relating to social networks prior to hospitalization. Among these, the mean age was 14.7 years, 42.9% were female, and the mean duration of untreated psychosis was 19.7 weeks.

A total of 38 patients were deemed to have stable social networks, while the remaining 46 reported declining networks prior to hospitalization.

The authors reported that patients with declining social support had a significantly longer duration of untreated psychosis (25.4 weeks), compared with patients who had stable support systems (12.6 weeks; P less than .05).

Mr. DeVylder and Dr. Gearing also found that patients who reported declining social support were more likely to experience primarily negative symptoms during this prodromal period and less likely to experience manic symptoms.

"No association was found between gender and social support in this study, in contrast to prior findings [Psychol. Med. 2012;42;769-80] in a larger sample predominantly of adults (mean age 32 years) that males have more severe social disability at first episode of psychosis," the investigators added.

Nor was the presence of depression prior to hospitalization associated with social networks.

The study was hampered by its retrospective design, since it did not "allow us to examine specifically whether the decline in social support occurred following psychosis onset or during the prodromal phase, which has been associated with social impairment, or to determine causality in the associations between symptom profile and social support," the researchers conceded.

Nevertheless, "future studies should further examine the trajectory of change in the early course of psychosis with regards to social support as well as other clinical symptoms, either with adolescents at clinical high risk for psychosis or those in the early stages of overt symptoms."

Mr. DeVylder and Dr. Gearing disclosed no conflicts of interest and no outside funding.

Adolescents experiencing negative symptoms prior to first psychotic episode were more likely to have declining social support prior to hospitalization, compared with adolescents who exhibited manic prodromal symptoms.

Indeed, "these results provide initial information on the identification of adolescents at highest risk for experiencing a decline in social support, who therefore may particularly benefit from focused intervention," J. E. DeVylder and R.E, Gearing reported in the journal Psychiatry Research.

Mr. DeVylder, a doctoral candidate at the Columbia University School of Social Work, New York, and Dr. Gearing, also of Columbia, looked at archival data from hospital records of inpatient psychiatric units in Ontario, Canada.

Patients were included if they were younger than 18 years of age at the time of hospital admission, hospitalized for a first episode of a primary psychotic disorder (nonaffective or affective), and discharged between Jan. 1, 1999 and Oct. 31, 2003. About one-third of the participants were born in a foreign country.

Nonfamilial social support was judged to be either declining, stable, or improving during the period prior to hospitalization, based on clinician judgment of peer relationships as well as social support and peer relations information from the patients, hospital staff, and collateral contacts, the authors wrote (Psychiatry Res. 2013 Feb. 28 [doi:10.1016/j.psychres.2013.02.004]).

"Only declining and stable were included in this study as no respondents endorsed an increased number of peer relationships," they added.

A total of 84 patients completed mail-in surveys and had all available information on record relating to social networks prior to hospitalization. Among these, the mean age was 14.7 years, 42.9% were female, and the mean duration of untreated psychosis was 19.7 weeks.

A total of 38 patients were deemed to have stable social networks, while the remaining 46 reported declining networks prior to hospitalization.

The authors reported that patients with declining social support had a significantly longer duration of untreated psychosis (25.4 weeks), compared with patients who had stable support systems (12.6 weeks; P less than .05).

Mr. DeVylder and Dr. Gearing also found that patients who reported declining social support were more likely to experience primarily negative symptoms during this prodromal period and less likely to experience manic symptoms.

"No association was found between gender and social support in this study, in contrast to prior findings [Psychol. Med. 2012;42;769-80] in a larger sample predominantly of adults (mean age 32 years) that males have more severe social disability at first episode of psychosis," the investigators added.

Nor was the presence of depression prior to hospitalization associated with social networks.

The study was hampered by its retrospective design, since it did not "allow us to examine specifically whether the decline in social support occurred following psychosis onset or during the prodromal phase, which has been associated with social impairment, or to determine causality in the associations between symptom profile and social support," the researchers conceded.

Nevertheless, "future studies should further examine the trajectory of change in the early course of psychosis with regards to social support as well as other clinical symptoms, either with adolescents at clinical high risk for psychosis or those in the early stages of overt symptoms."

Mr. DeVylder and Dr. Gearing disclosed no conflicts of interest and no outside funding.