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Open Access Research article

Evaluating differential developmental trajectories to adolescent-onset mood and psychotic disorders

Ian B Hickie1*, Daniel F Hermens1, Sharon L Naismith1, Adam J Guastella1, Nick Glozier1, Jan Scott234 and Elizabeth M Scott15

Author Affiliations

1 Clinical Research Unit, Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia

2 Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK

3 Centre for Affective Disorders, Institute of Psychiatry, London, UK

4 Academic Psychiatry, Wolfson Unit, Centre for Ageing & Vitality, Newcastle , UK

5 School of Medicine, University of Notre Dame, Sydney, Australia

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BMC Psychiatry 2013, 13:303  doi:10.1186/1471-244X-13-303

Published: 12 November 2013

Abstract

Background

It is an open question as to whether differential developmental trajectories, potentially representing underlying pathophysiological processes, can form the basis of a more useful typology in young persons who present for mental health care.

Methods

A cohort of 605 young people was recruited from youth mental health services that target the early phases of anxiety, mood or psychotic disorders. Participants were assigned to one of three clinical sub-types (anxious-depression; mania-fatigue; developmental-psychotic) according to putative developmental trajectories.

Results

The distribution of subtypes was: 51% anxiety-depression, 25% mania-fatigue and 24% developmental-psychotic, with key differences in demographic, clinical, family history and neuropsychological characteristics. When analyses were limited to 286 cases with ‘attenuated’ or sub-threshold syndromes, the pattern of differences was similar. Multinomial logistic regression demonstrated that compared to the developmental-psychotic subtype, both the mania-fatigue and anxiety-depression subtypes were younger and more depressed at presentation, but less functionally impaired. Other discriminating variables between the developmental-psychotic and mania-fatigue sub-types were that the latter were significantly more likely to have a family history of bipolar disorder but have less likelihood of impaired verbal learning; whilst the anxious-depression group were more anxious, more likely to have a family history of depression, and had a higher premorbid IQ level.

Conclusions

This cross-sectional evaluation provides preliminary support for differing developmental trajectories in young persons presenting for mental health care. Prospective follow-up is needed to examine the predictive validity of this approach and its relationships to underlying pathophysiological mechanisms.

Keywords:
Youth; Neuropsychology; Clinical staging; Sub-syndromal; Phenotype; Illness trajectory