Family history influences age at prodrome and psychosis onset

By Mark Cowen

A family history of psychosis is associated with an earlier age at onset of both prodromal symptoms and full-blown psychosis, US research shows.

The team found that patients with a first episode of psychosis who had a family history of psychosis developed prodromal symptoms and full-blown psychosis around 3 years earlier than those without such a history, and had a longer duration of untreated psychosis.

"The findings have implications for understanding the impact of specific family-related mechanisms on both clinical and help-seeking factors, as well as for informing future family-based intervention efforts," comment the authors in Psychiatry Research.

Michelle Esterberg (Veterans Affairs Puget Sound Health Care System, Seattle, Washington) and Michael Compton (George Washington University School of Medicine and Health Sciences, Washington, District of Columbia) studied 152 patients hospitalized with a first episode of psychosis.

Of the participants, 23 (15.1%) had a family history of psychosis in first degree relatives. There were no significant differences between patients with and without a family history of psychosis regarding mean age, race/ethnicity, or distribution of type of psychotic disorder.

However, patients with a family history of psychosis developed prodromal symptoms at an average age of 16.1 years versus 19.2 years in those without such a history, and the respective ages at onset of full-blown psychosis were 18.3 and 21.6 years.

Patients with a family history of psychosis also had a longer duration of untreated psychosis than patients without such a history, at 57 versus 21 weeks.

However, there were no significant between-group differences regarding the duration of the prodromal period.

Further analysis revealed that a family history of psychosis and gender interacted to influence severity of negative, but not positive, symptoms.

Specifically, men with a family history of psychosis had significantly more severe negative symptoms than men without such a history, with mean negative symptom scores of 25.5 versus 21.2 on the Positive and Negative Syndrome Scale (PANSS).

By contrast, women with a family history of psychosis had less severe negative symptoms than women without such a history, with mean PANSS negative symptom scores of 16.7 versus 21.0.

Esterberg and Compton conclude: "The present study adds to an existing body of research suggesting that family history of psychosis is associated with a younger age at onset of psychosis, and is one of the first to demonstrate that family history acts similarly on age at onset of the prodrome."

They add: "Future research should focus on attempting to understand potential mediators and moderators of family history and its influence on the clinical presentation in schizophrenia."

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