title: Psychodynamic-oriented psychological assessment predicts evolution to schizophrenia at 8-year follow-up in adolescents hospitalized for a manic/mixed episode: interest of an overall subjective rating.
abstract: Little is known concerning the prognostic significance of manic/mixed episodes in adolescents. In particular, whether the use of psychodynamic-oriented projective psychological testing predicts evolution to schizophrenia at follow-up has not been established. Eighty subjects, aged 12-20years old, consecutively hospitalized for a manic or mixed episode between 1994 and 2003 were recruited. All patients were contacted in 2005-2006 for a follow-up assessment. For the subgroup of adolescents (N=40) who had psychodynamic-oriented psychological testing (Rorschach and TAT), two scores regarding psychosocial risk and schizophrenia risk were computed using the clinical global impression (CGI) assessment based on an overall subjective rating given by a panel of expert psychologists who reviewed all protocols. At follow-up (average 8years), 25 (62.5%) patients, 16 females and nine males, were assessed: 14 still had a diagnosis of bipolar disorder; eight changed to schizo-affective disorder and three to schizophrenia. Inter-rater reliability of both CGI-risk scores (psychosocial risk and schizophrenia risk) showed good clinical consensus with intraclass correlation and Kappa scores ranging from 0.53 to 0.75. Univariate analysis showed that CGI-psychosocial risk score (p=0.017), type of index episode (p=0.049) and CGI-schizophrenia risk score (p=0.09) were associated with transition to schizophrenia spectrum disorder at follow-up. Age, sex, socioeconomic status, duration of stay and the presence of psychotic features at index episode were not associated with the transition. We conclude that the CGI assessment appears to be valid to score risk of poor outcome using psychodynamic-oriented psychological testing and that these scores may predict, in part, the transition to schizophrenia in adolescents with a history of manic/mixed episode.
authors.affiliation: Department of Child and Adolescent Psychiatry, UPMC, APHP, GH Pitié-Salpétrière, Paris, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Louët
authors.forename: Angèle
authors.initials: A
authors.lastname: Consoli
authors.forename: Raffaella
authors.initials: R
authors.lastname: Lucanto
authors.forename: Nicole
authors.initials: N
authors.lastname: Duplant
authors.forename: Marie-José
authors.initials: MJ
authors.lastname: Bailly-Salin
authors.forename: Annie
authors.initials: A
authors.lastname: Lemoigne
authors.forename: Michèle
authors.initials: M
authors.lastname: Martin
authors.forename: Charlotte
authors.initials: C
authors.lastname: Mayer
authors.forename: Caroline
authors.initials: C
authors.lastname: Thompson
authors.forename: Fanny
authors.initials: F
authors.lastname: Gollier-Briant
authors.forename: Claudine
authors.initials: C
authors.lastname: Laurent
authors.forename: Julie
authors.initials: J
authors.lastname: Brunelle
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bodeau
authors.forename: David
authors.initials: D
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D001714:Bipolar Disorder / Q000150:complications / Q000175:diagnosis* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011572:Psychoanalysis / Q000592:standards; D012189:Retrospective Studies; D012559:Schizophrenia / Q000175:diagnosis* / Q000209:etiology; D012565:Schizophrenic Psychology; D055815:Young Adult