title: Is it still correct to differentiate between early and very early onset psychosis?
abstract: OBJECTIVE
  It remains unclear whether very early onset psychosis (VEOP; ≤12years of age) and early onset psychosis (EOP; onset 13-17years of age) are homogeneous in their clinical presentation. We investigated the predictive value of age of psychosis onset for severity, functioning and demographic variation by: 1) comparing groups based on traditional cut-offs for age of psychosis onset, and 2) using receiver operating characteristic (ROC)-curve calculations, without a priori age of onset cut-offs.
  
  
  METHODS
  Participants were 88 (45 female, 43 male) children and adolescents with a recent onset of psychosis (age range=6.7-17.5years; M=13.74, SD=2.37).
  
  
  RESULTS
  The VEOP group had significantly shorter duration of untreated illness and untreated psychosis, and lower functioning than the EOP group. The VEOP and EOP groups did not differ significantly on gender proportion, urbanicity, psychotic diagnosis, family history of psychotic disorder, psychotic, depressive and anxiety symptoms or IQ. When applying ROC-curves to the lowest three quartiles of positive psychotic symptoms scores, the optimal age-cut-off was 14.0years (sensitivity=0.62; specificity=0.75). For the highest quartile of functioning scores, the optimal differentiating cut-off for age of psychosis onset was 14.7years (sensitivity=0.71; specificity=0.70).
  
  
  CONCLUSIONS
  Larger samples of patients, assessed at presentation and followed-up, are necessary to clearly examine clinical presentation and outcome as a function of social and neural development to better understand if the differentiation between VEOP and EOP is justified. This will aid the development of predictive diagnostic tools, more accurate prognosis prediction, and age-tailored therapeutic interventions.
authors.affiliation: Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, 6008, Western Australia, Australia.
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Lin
authors.affiliation: Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Klaas J
authors.initials: KJ
authors.lastname: Wardenaar
authors.affiliation: Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Pontillo
authors.affiliation: Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: De Crescenzo
authors.affiliation: Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Mazzone
authors.affiliation: Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Vicari
authors.affiliation: School of Psychology, University of Birmingham, Edgbaston B15 2TT, United Kingdom; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, Victoria 3053, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Wood
authors.affiliation: School of Psychology, University of Birmingham, Edgbaston B15 2TT, United Kingdom.
authors.forename: Amanda
authors.initials: A
authors.lastname: Beavan
authors.affiliation: Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy; Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland. Electronic address: marco.armando@opbg.net.
authors.forename: Marco
authors.initials: M
authors.lastname: Armando
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D017668:Age of Onset; D019540:Area Under Curve; D001714:Bipolar Disorder / Q000145:classification* / Q000175:diagnosis; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000145:classification* / Q000175:diagnosis; D012372:ROC Curve; D012559:Schizophrenia / Q000145:classification* / Q000175:diagnosis
keywords: Childhood onset; First-episode psychosis; ROC-curves; Schizophrenia; Very early and early onset psychosis