Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Introduction: Primary psychotic disorders and mood disorders with psychotic features are serious and persistent mental health disorders that are increasingly being diagnosed in children and adolescents. Current relapse rates range from 34% within 6 months to over 80% within five years in adult patients with primary psychotic disorders and mood disorders with psychotic features. To date, no research has exclusively addressed relapse for the juvenile onset of these disorders.

Objectives: To critically examine the relapse rate, and associated predictors, of children and adolescents following their first-episode primary psychotic disorders or mood disorders with psychotic features, for which they were treated in an inpatient psychiatric hospital unit. This study constructed a Kaplan-Meier survival curve for time to first-relapse; conducted univariate survival analysis on 25 risk variables associated with time to first-relapse; and developed the first statistical risk-model for prediction of time to first relapse for children and adolescents diagnosed with primary psychotic disorders or mood disorders with psychotic features following first-episode hospital admission.

Methods: This research followed a retrospective follow-up longitudinal cohort research design. This multi-site study critically examines the relapse rate and associated predictors for children and adolescents following their first-episode of primary psychotic disorder or mood disorder with psychotic features. Participants were recruited across six inpatient psychiatric hospital units from which they were treated. A total of 87 (N = 87) Children and youth were followed for a minimum of two-years.

Results: Of the 87 participants, almost sixty percent (57%) experienced a recurrence by the end of follow-up, half of them within 34 months. A Cox Proportional Hazards Regression identified four key risk factors for relapse: adherence to medication, gender, clinical treatment, and maintenance of social support prior to first admission.

Conclusions: The Kaplan Meier analysis revealed that 50% (95% CI = 19.3% to 67.1%) of children and adolescents following a first-episode of primary psychotic disorders or mood disorders with psychotic features, for which they were treated in inpatient psychiatric hospital units, will relapse, requiring a second psychiatric inpatient hospitalization within 34 months. A Cox Proportional Hazards model predicted that having an event (relapse) in the worse case is 33 times more likely than in the best case. Where the best case would be a male, who is adherent to medication, with an unchanged social support network, and not currently receiving clinical treatment; and the worse case would be a female, who is non-adherent to medication, with a decreased social support network, and currently receiving clinical treatment. Clinical, policy, and research implications will be discussed.