Abstract
Individuals with 22q11.2 Deletion Syndrome (22q11.2DS) are at substantial increased risk of psychosis spectrum outcomes including schizophrenia. We conducted a prospective, longitudinal study of the psychopathological and neurocognitive correlates of early psychotic phenomena in young people with 22q11.2DS (n = 75, mean age time 1 (T1) 9.9 years, time 2 (T2) 12.5 years). We also assessed unaffected control siblings (n = 33, mean age T1 10.6 years, T2 13.4 years). The prevalence of psychotic experiences, defined as subthreshold psychotic phenomena, substantially increased in children with 22q11.2DS from 4% (n = 3) in childhood (T1) to 21% (n = 16) in early adolescence (T2) (p = 0.001), and at T2 prevalence was significantly elevated (p = 0.020) relative to control siblings (3%). The emergence of psychotic experiences was associated with levels of childhood anxiety symptoms at T1 and differential development of the attention-executive domain. IQ ability and IQ change, however, were not associated with the emergence of psychotic experiences, indicating that initial changes in attention-executive functioning may precede the decline in global cognition that has been reported to be associated with later stages of psychosis development. Our study highlights that psychotic phenomena emerge early in 22q11.2DS and we implicate attention-executive functioning and anxiety as key domains associated with the development of these psychotic experiences.
Highlights
Identifying the early antecedents of psychotic disorders is vital for understanding aetiology and informing potential interventions, but does provide a challenge for researchers
This investigation was based on the ongoing CF24 4HQ (Cardiff) longitudinal ECHO study. 75 children with 22q11.2DS (mean age in years (SD), time 1 (T1) = 9.9 (2.4); time 2 (T2) = 12.5(2.3), 44 (59%) male) and 33 sibling controls closest in age to the index child (mean (SD), T1 = 10.6 (2.0), T2 = 13.4(2.0), 17 (52%) male) were assessed and the study captures the developmental stage of early adolescence
Within children with 22q11.2DS we examined whether the presence of psychotic experiences at T2 was associated with the following demographics: age using an independent t-test; gender, 22q11.2DS origin and ethnicity using Fisher's exact test; household income and maternal education using Mann-Whitney U tests
Summary
Identifying the early antecedents of psychotic disorders is vital for understanding aetiology and informing potential interventions, but does provide a challenge for researchers. Studies of individuals at clinical high-risk of psychosis, insightful, capture the end phases of the disease process and are unable to assess earlier premorbid phases. Large cohort studies of the general population have provided insights into the childhood antecedents of psychosis. Given the prevalence of psychosis in the general population (2.3–3.5%) (Perälä et al, 2007; van Os and Kapur, 2009), the number of individuals who develop psychosis in cohort studies is small. Studies of high-risk groups, where a high proportion of young people will develop psychotic spectrum outcomes, represents an effective methodology, as individuals can be tracked through the period of increasing psychosis risk
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