Most psychiatric disorders begin before the age of 25, yet there’s still a lot we don’t know about the way people transition from early stages of a psychiatric disorder – having a particular episode or symptoms – to a full-blown condition.

And because psychiatric disorders hit young people, they’re a big contributor to early death, disability, and chronic illness. That’s why work is going on into finding out how we can spot these conditions earlier, get people into treatment and prevent a cycle of ill health.

In this Australian study, the researchers wanted to know more about the pathways people take from early presentations to a healthcare practice for a psychiatric disorder (or symptoms) through to more serious illness.

They looked at almost 3000 young people – between the ages of 12 and 25, but with an average of 18 – who presented to youth mental health clinics in Sydney. Some were diagnosed with mild psychiatric symptoms – moderate depression, arousal and anxiety and impaired functioning.

Others were diagnosed with more severe symptoms, with the most severe category including mania, psychosis, severe depression and anxiety. These people were followed for about a year, and in some cases longer.

About 600 people were diagnosed with mild psychiatric symptoms, and more than a third of them transitioned to more severe symptoms – what they called an ‘attenuated’ (or distinct) syndrome.

The researchers found that this transition was linked to a number of factors in a person’s life – things like their engagement with education and employment, self-harm and older age.

By understanding who’s at risk of progressing to more severe mental illness, we can target treatments to those who need it most.

Of those who’d had a psychotic-like experience – which could be thinking abnormally, believing yourself to be persecuted, more than a thousand were diagnosed with an attenuated syndrome in their first visit – and their movement to a ‘full-threshold,’ or especially severe psychiatric illness was linked to psychotic-like experiences, childhood psychiatric disorders and ‘circadian disturbance’ – a significantly disrupted or altered sleep pattern.

Implications

By understanding how people move between different stages of a psychiatric illness and the factors that could make them more or less likely to transition to severe disability, we can target interventions early and reduce the overall burden of psychiatric illness.

Last Reviewed: 27/04/2020

© Norman Swan Medical Communications.



References

For reference: Iorfino, et al (2019). Clinical Stage Transitions in Persons Aged 12 to 25 Years Presenting to Early Intervention Mental Health Services With Anxiety, Mood, and Psychotic Disorders. JAMA Psychiatry doi: 10.1001/jamapsychiatry.2019.2360.

%d bloggers like this: