title: Predictors of functional and clinical outcome in early-onset first-episode psychosis: the child and adolescent first episode of psychosis (CAFEPS) study.
abstract: OBJECTIVE
  The objective of this study was to study baseline clinical and biological predictors of 2-year outcome in a cohort of children and adolescents with a first episode of psychosis.
  
  
  METHODS
  Standard instruments were used to evaluate symptoms and functioning in 110 children and adolescents (mean age = 15.47 years) with first episode of psychosis at admission (between 2003 and 2005) and after 2-year follow-up. Clinical assessments included diagnostic assessment to yield DSM-IV diagnosis, developmental, premorbid, and past-year data, together with structural neuroimaging and other biological parameters (genetics and oxidative stress). Eighty-three subjects had assessments at baseline (including the Strauss-Carpenter Outcome Scale [SCOS]) and at 2-year follow-up. Association and multistep regression analyses were conducted to show correlates and predictors of primary outcome measures: functional outcome (Children's Global Assessment Scale [CGAS]), improvement (CGAS change), and primary negative symptoms (Proxy for the Deficit Syndrome Scale).
  
  
  RESULTS
  The SCOS predicted 27.46% (P < .001) of the variance in CGAS score at 2 years. Baseline severity (measured by CGAS) predicted 30.9% (P < .001) of CGAS improvement after 2 years, and SCOS total score predicted an added 24.1% (P < .001). A diagnosis of nonaffective psychosis, primary negative symptoms, and less white matter at baseline predicted more primary negative symptoms at follow-up. The prediction of functional outcome was not increased by genetic, oxidative stress, or neurostructural markers.
  
  
  CONCLUSIONS
  Baseline clinical assessments have a better predictive value than biological assessments for 2-year follow-up functioning of children and adolescents with a first episode of psychosis. Patients with primary negative symptoms at baseline continue to have negative symptoms 2 years later, and neurostructural markers predict these. Clinicians must still rely on clinical variables to judge the functional prognosis of early-onset first psychotic episodes.
authors.affiliation: Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Ibiza 43, Madrid 28009, Spain parellada@hggm.es.
authors.forename: Mara
authors.initials: M
authors.lastname: Parellada
authors.forename: Josefina
authors.initials: J
authors.lastname: Castro-Fornieles
authors.forename: Ana
authors.initials: A
authors.lastname: Gonzalez-Pinto
authors.forename: Laura
authors.initials: L
authors.lastname: Pina-Camacho
authors.forename: Dolores
authors.initials: D
authors.lastname: Moreno
authors.forename: Marta
authors.initials: M
authors.lastname: Rapado-Castro
authors.forename: Soraya
authors.initials: S
authors.lastname: Otero
authors.forename: Elena
authors.initials: E
authors.lastname: de la Serna
authors.forename: Carmen
authors.initials: C
authors.lastname: Moreno
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Baeza
authors.forename: Montserrat
authors.initials: M
authors.lastname: Graell
authors.forename: Celso
authors.initials: C
authors.lastname: Arango
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D042241:Early Diagnosis; D061345:Early Medical Intervention; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care / Q000379:methods*; D062706:Prodromal Symptoms; D011379:Prognosis; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D012720:Severity of Illness Index; D013997:Time Factors