Diagnostic specificity of the child psychosis-risk screening system with a focus on the differentiation of schizophrenia spectrum disorders and neurodevelopmental disorders

Research on early psychosis has begun to identify psychiatric characteristics of the prodromal period of schizophrenia; however, subclinical characteristics of children in non-psychiatric fields have not been fully investigated. In our previous study, we developed the Child Psychosis-risk Screening System (CPSS).In the present cross-sectional study, we attempted to identify the risk of developing psychosis in pediatric (n = 216) and psychiatric outpatients (n = 120), aged 6– 18 years, with the CPSS.An analysis of variance of CPSS risk was performed in six diagnostic categories to examine specificity for each diagnosis. Receiver operating characteristic (ROC) curve analysis was conducted using the onset of schizophrenia spectrum as the outcome, and the discriminatory power and cut off values of the CPSS were determined. Logistic regression analysis was performed using clinical data to identify factors associated with the risk group (those at high risk of developing psychosis in the future) identified using the CPSS.There were significant differences in risk variance among diagnostic categories (p < 0.001), especially between schizophrenia spectrum disorders (SSD) and neurodevelopmental disorders (p = 0.001). CPSS had sufficient discriminatory power for SSD diagnosis [area under the ROC curve = 0.853 (95% confidence interval: 0.774–0.931)]. The cut off value for the risk of SSD was determined to be 98.1%, achieving the best mean of the sum of sensitivity (90.9%) and specificity (84.0%). Cross-sectional logistic regression analysis showed that along with “SSD diagnosis,” “winter birth,” and “maltreatment” were factors associated with the risk group (odds ratio = 38.05 [p = 0.001], 2.30 [p = 0.016], and 0.12 [p = 0.024], respectively).CPSS may have potential use in the early detection of psychosis and differentiation from neurodevelopmental disorders, but this study was small and further studies with larger sample sizes and longitudinal study designs are required prior to its use in routine clinical practice.

[1]  T. Hikida,et al.  Preliminary study of the social withdrawal (hikikomori) spectrum in French adolescents: focusing on the differences in pathology and related factors compared with Japanese adolescents , 2022, BMC Psychiatry.

[2]  F. Larøi,et al.  A systematic review of premorbid cognitive functioning and its timing of onset in schizophrenia spectrum disorders , 2022, Schizophrenia Research: Cognition.

[3]  Jerome H. Taylor,et al.  Commentary: Schizophrenia prevention and prodromal psychosis in children and adolescents. , 2021, Journal of child psychology and psychiatry, and allied disciplines.

[4]  A. Zuddas,et al.  A Neurodevelopment Approach for a Transitional Model of Early Onset Schizophrenia , 2021, Brain sciences.

[5]  T. Hikida,et al.  Combined pattern of childhood psycho-behavioral characteristics in patients with schizophrenia: a retrospective study in Japan , 2021, BMC Psychiatry.

[6]  Katherine S. F. Damme,et al.  Sensorimotor and Activity Psychosis-Risk (SMAP-R) Scale: An Exploration of Scale Structure With Replication and Validation. , 2020, Schizophrenia bulletin.

[7]  T. Hikida,et al.  Identifying Social Withdrawal (Hikikomori) Factors in Adolescents: Understanding the Hikikomori Spectrum , 2020, Child Psychiatry & Human Development.

[8]  C. Correll,et al.  Annual Research Review: Prevention of psychosis in adolescents - systematic review and meta-analysis of advances in detection, prognosis and intervention. , 2020, Journal of child psychology and psychiatry, and allied disciplines.

[9]  O. Andreassen,et al.  Genetic liability for schizophrenia and childhood psychopathology in the general population , 2020, medRxiv.

[10]  M. Cannon,et al.  O10.3. EARLY CHILDHOOD DEVELOPMENT AND LATER PSYCHOTIC EXPERIENCES: FINDINGS FROM THE RAINE STUDY , 2020, Schizophrenia Bulletin.

[11]  P. Hastings,et al.  Predicting psychosis-spectrum diagnoses in adulthood from social behaviors and neighborhood contexts in childhood , 2019, Development and Psychopathology.

[12]  R. Murray,et al.  Prenatal and perinatal risk and protective factors for psychosis: a systematic review and meta-analysis. , 2020, The lancet. Psychiatry.

[13]  I. Baeza,et al.  Neuropsychological profile of children and adolescents with psychosis risk syndrome: the CAPRIS study , 2020, European Child & Adolescent Psychiatry.

[14]  D. Barch,et al.  Replication of Associations With Psychotic-Like Experiences in Middle Childhood From the Adolescent Brain Cognitive Development (ABCD) Study , 2020, Schizophrenia bulletin open.

[15]  A. Pichiecchio,et al.  Predictors of Outcomes in Adolescents With Clinical High Risk for Psychosis, Other Psychiatric Symptoms, and Psychosis: A Longitudinal Protocol Study , 2019, Front. Psychiatry.

[16]  T. Schulze,et al.  Childhood Trauma in Schizophrenia: Current Findings and Research Perspectives , 2019, Front. Neurosci..

[17]  J. van os,et al.  Psychotic experiences are associated with health anxiety and functional somatic symptoms in preadolescence. , 2018, Journal of child psychology and psychiatry, and allied disciplines.

[18]  E. Youngstrom,et al.  Diagnostic efficiency of the CBCL thought problems and DSM-oriented psychotic symptoms scales for pediatric psychotic symptoms , 2018, European Child & Adolescent Psychiatry.

[19]  B. Rund.  The research evidence for schizophrenia as a neurodevelopmental disorder. , 2018, Scandinavian journal of psychology.

[20]  T. S. Sathyanarayana Rao,et al.  Understanding the schizophrenia prodrome , 2017, Indian journal of psychiatry.

[21]  P. McGuire,et al.  Improving Prognostic Accuracy in Subjects at Clinical High Risk for Psychosis: Systematic Review of Predictive Models and Meta-analytical Sequential Testing Simulation , 2016, Schizophrenia bulletin.

[22]  A. Rossi,et al.  Characterization of premorbid functioning during childhood in patients with deficit vs. non-deficit schizophrenia and in their healthy siblings , 2016, Schizophrenia Research.

[23]  Dennis R. Grayson,et al.  Altering the course of schizophrenia: progress and perspectives , 2016, Nature Reviews Drug Discovery.

[24]  P. McGorry.  Early Intervention in Psychosis , 2015, The Journal of nervous and mental disease.

[25]  P. Falkai,et al.  The impact of environmental factors in severe psychiatric disorders , 2014, Front. Neurosci..

[26]  K. Laurens,et al.  Systematic meta-analysis of childhood social withdrawal in schizophrenia, and comparison with data from at-risk children aged 9-14 years. , 2013, Journal of psychiatric research.

[27]  J. Castro-Fornieles,et al.  Premorbid impairments in early-onset psychosis: Differences between patients with schizophrenia and bipolar disorder , 2013, Schizophrenia Research.

[28]  H. Tanii,et al.  Associations between psychotic-like experiences and mental health status and other psychopathologies among Japanese early teens , 2008, Schizophrenia Research.

[29]  R. Murray,et al.  Psychotic-like experiences and other antecedents of schizophrenia in children aged 9–12 years: a comparison of ethnic and migrant groups in the United Kingdom , 2007, Psychological Medicine.

[30]  G. Andrews,et al.  Association between trauma exposure and delusional experiences in a large community-based sample , 2007, British Journal of Psychiatry.

[31]  R. Murray,et al.  Community screening for psychotic-like experiences and other putative antecedents of schizophrenia in children aged 9–12 years , 2007, Schizophrenia Research.

[32]  A. Yung,et al.  Mapping the Onset of Psychosis: The Comprehensive Assessment of At-Risk Mental States , 2005 .

[33]  Jeffrey A. Lieberman,et al.  International clinical practice guidelines for early psychosis , 2005, British Journal of Psychiatry.

[34]  H. Möller,et al.  Early detection and secondary prevention of psychosis: facts and visions* , 2004, European Archives of Psychiatry and Clinical Neuroscience.

[35]  P. Delespaul,et al.  Formation of delusional ideation in adolescents hearing voices: a prospective study. , 2002, American journal of medical genetics.

[36]  Richie Poulton,et al.  Evidence for early-childhood, pan-developmental impairment specific to schizophreniform disorder: results from a longitudinal birth cohort. , 2002, Archives of general psychiatry.

[37]  S. Lawrie,et al.  Childhood behaviour, psychotic symptoms and psychosis onset in young people at high risk of schizophrenia: early findings from the Edinburgh High Risk Study , 2002, Psychological Medicine.

[38]  P. Stratta,et al.  Behavioral neurodevelopment abnormalities and schizophrenic disorder: a retrospective evaluation with the Childhood Behavior Checklist (CBCL) , 2000, Schizophrenia Research.

[39]  F. Verhulst,et al.  Empirically based assessment and taxonomy of psychopathology: Cross-cultural applications. A review , 1995, European Child & Adolescent Psychiatry.

[40]  M Marmot,et al.  Child developmental risk factors for adult schizophrenia in the British 1946 birth cohort , 1994, The Lancet.

[41]  H. Koot,et al.  Cross-cultural generalizability of the child behavior checklist cross-informant syndromes , 1994 .

[42]  R. Murray,et al.  Is schizophrenia a neurodevelopmental disorder? , 1987, British medical journal.

[43]  D. Weinberger.  Implications of normal brain development for the pathogenesis of schizophrenia. , 1987, Archives of general psychiatry.

[44]  S. Mednick,et al.  Behavioral precursors of schizophrenia spectrum. A prospective study. , 1982, Archives of general psychiatry.

[45]  J. Zubin,et al.  Vulnerability--a new view of schizophrenia. , 1977, Journal of abnormal psychology.

[46]  D. Posthuma,et al.  Polygenic scores for schizophrenia and educational attainment are associated with behavioural problems in early childhood in the general population , 2018, Journal of child psychology and psychiatry, and allied disciplines.

[47]  R. Murray,et al.  Genetic and environmental risk factors for schizophrenia , 2009 .

[48]  E. Torrey,et al.  A systematic review and meta-analysis of Northern Hemisphere season of birth studies in schizophrenia. , 2003, Schizophrenia bulletin.

[49]  G. Huber.  [The concept of substrate-close basic symptoms and its significance for the theory and therapy of schizophrenic diseases]. , 1983, Der Nervenarzt.