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Affective symptom dimensions in early-onset psychosis over time: a principal component factor analysis of the Young Mania Rating Scale and the Hamilton Depression Rating Scale

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Abstract

Early-onset psychosis (EOP) is a complex disorder characterized by a wide range of symptoms, including affective symptoms. Our aim was to (1) examine the dimensional structure of affective symptoms in EOP, (2) evaluate the predominance of the clinical dimensions and (3) assess the progression of the clinical dimensions over a 2-year period. STROBE-compliant prospective principal component factor analysis of Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale-21 (HDRS-21) at baseline, 6-months, 1-year and 2-year follow-up. We included 108 EOP individuals (mean age = 15.5 ± 1.8 years, 68.5% male). The factor analysis produced a four-factor model including the following dimensions: mania, depression/anxiety, sleep and psychosis. It explained 47.4% of the total variance at baseline, 60.6% of the total variance at 6-months follow-up, 54.5% of the total variance at 1-year follow-up and 49.5% of the total variance at 2-year follow-up. According to the variance explained, the mania factor was predominant at baseline (17.4%), 6-month follow-up (23.5%) and 2-year follow-up (26.1%), while the depression/anxiety factor was predominant at 1-year follow-up (23.1%). The mania factor was the most stable; 58.3% items that appeared in this factor (with a load > 0.4) at any time point appeared in the same factor at ≥ 3/4 time points. Affective symptoms are frequent and persistent in EOP. Mania seems to be the most predominant and stable affective dimension. However, depression and anxiety may gain predominance with time. A comprehensive evaluation of the dimensional structure and the progression of affective symptoms may offer clinical and therapeutic advantages.

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Funding

This study has been supported by the Spanish Ministry of Science, Innovation, and Universities, Instituto de Salud Carlos III, European Regional Development Fund “A way of making Europe,” Centro de Investigación Biomédica en Red Salud Mental, Madrid Regional Government; Fundación Alicia Koplowtiz and Fundación Mutua Madrileña. GSP was supported by the Alicia Koplowitz Foundation. DM, CA, MR-C and CM were partially supported by the Spanish Ministry of Science and Innovation and the Instituto de Salud Carlos III (PI15/00723, PI17/02227, PI18/00753), co-financed by ERDF Funds from the European Commission, “A way of making Europe,” CIBERSAM, Madrid Regional Government (B2017/BMD-3740 AGES-CM-2), European Union Structural Funds, European Union Seventh Framework Programme and European, Union Seventh Framework Program under grant agreements FP7-HEALTH-2009-2.2.1-2-241909 (Project EU-GEI), FP7-HEALTH-2009-2.2.1-3-242114 (Project OPTiMISE), FP7- HEALTH-2013-2.2.1-2-603196 (Project PSYSCAN) and FP7- HEALTH-2013- 2.2.1-2-602478 (Project METSY); and European Union H2020 Program under the Innovative Medicines Initiative 2 Joint Undertaking (Grant Agreement No 115916, Project PRISM, and Grant Agreement No 777394, Project AIMS-2-TRIALS), Fundación Familia Alonso and Fundación Alicia Koplowitz and Fundación Mutua Madrileña. IB was supported by Instituto de Salud Carlos III (INT19/0021). MR-C was supported by a Ramon y Cajal Research Fellowship (RYC-2017-23144), Spanish Ministry of Science, Innovation and Universities and an NARSAD independent investigator grant (24628) from the Brain & Behavior Research Foundation.

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Author notes

  1. Marta Rapado-Castro and Carmen Moreno are equally contributing authors.

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain

    Gonzalo Salazar de Pablo, Dolores Moreno, Celso Arango, Marta Rapado-Castro & Carmen Moreno

  2. Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Gonzalo Salazar de Pablo

  3. Department of Psychiatry, Biomedical Research Networking Centre in Mental Health, BioAraba Research Institute, OSI Araba-University Hospital, University of the Basque Country (EHU/UPV), CIBERSAM, Vitoria, Spain

    Ana Gonzalez-Pinto

  4. Department of Child Psychiatry, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain

    Beatriz Paya

  5. Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Neurosciences Institute, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain

    Josefina Castro-Fonieles & Inmaculada Baeza

  6. Department of Medicine, University of Barcelona, Barcelona, Spain

    Josefina Castro-Fonieles

  7. Department of Child and Adolescent Psychiatry and Psychology, Hospital Infantil Universitario Niño Jesús, School of Medicine, Universidad Autónoma, Madrid, Spain

    Montserrat Graell

  8. Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Victoria, Australia

    Marta Rapado-Castro

Authors
  1. Gonzalo Salazar de Pablo
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  2. Dolores Moreno
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  3. Ana Gonzalez-Pinto
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  4. Beatriz Paya
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  6. Inmaculada Baeza
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  7. Montserrat Graell
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  8. Celso Arango
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  9. Marta Rapado-Castro
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Corresponding author

Correspondence to Marta Rapado-Castro.

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Conflict of interest

GSP has received honoraria from Janssen Cilag. DM has received honoraria from Otsuka-Lundbeck. IB has received honoraria or travel support from Angelini, Janssen and Otsuka-Lundbeck. MG has received travel support from Shire and Otsuka-Lundbeck. CA has been a consultant to or has received honoraria or grants from Acadia, Angelini, Gedeon Richter, Janssen Cilag, Lundbeck, Otsuka, Roche, Sage, Servier, Shire, Schering Plough, Sumitomo Dainippon Pharma, Sunovion and Takeda. CM has been a consultant to or has received honoraria from Janssen, Angelini, Servier, Nuvelution, Otsuka, Lundbeck and Esteve.

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Salazar de Pablo, G., Moreno, D., Gonzalez-Pinto, A. et al. Affective symptom dimensions in early-onset psychosis over time: a principal component factor analysis of the Young Mania Rating Scale and the Hamilton Depression Rating Scale. Eur Child Adolesc Psychiatry 31, 1715–1728 (2022). https://doi.org/10.1007/s00787-021-01815-5

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