Urgent Need for Intervention Services for Psychotic Youth, PhD Study Finds

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A UKZN study suggests there is a need for urgent dual intervention services for psychotic youth.

Conducted by Dr Saeeda Paruk, as part of her PhD, the study aimed to investigate associations between patterns of cannabis use and family history of psychosis or mental illness, and socio-demographic and clinical features of first-episode early onset psychosis (EOP) in adolescents.

Titled: “Risk Factors Associated with Adolescent Onset First Episode Psychosis in KwaZulu-Natal, South Africa”, it also aimed to compare family history of mental illness or psychosis as well as cannabis use patterns, between adolescents with psychotic and other first-episode non-psychotic mental illness.

‘The equally high prevalence of cannabis use in non-psychotic youth, which is often secondary to their mood symptoms, also reflects the need for improved screening and treatment for psychiatric disorders in adolescents with primary substance use,’ said Paruk.

She said this was the first prospective study of first episode psychosis in an exclusive adolescent sample in Africa that systematically analysed the impact of cannabis use on clinical presentation.

Said Paruk: ‘EOP (psychosis onset by age 18) often marks the beginning of a chronic severe mental disorder with a significant psychosocial and economic burden to the individual, family and community. Identifying the impact of risk factors for EOP may aid in delaying onset and/or modifying outcome.’

She said in contrast to research on adult psychosis, research on EOP was very limited internationally and there were no prospective studies from Africa.

‘Genetic vulnerability, often suggested by a family history of mental illness, as well as early cannabis exposure, has been associated with increased vulnerability to psychosis and earlier onset of disease,’ said Paruk.

‘There is thus a need to better understand the impact of these two established risk factors for psychosis (cannabis use and family history of mental illness) on the socio-demographic and clinical features (age of onset, age of presentation, duration of untreated psychosis and symptom profile) of first-episode EOP, to improve awareness, screening and early intervention programmes.’

The research results were reported in four papers.

The first paper revealed that adolescents with EOP had several negative outcome indicators such as poor recognition of the prodrome period, longer duration of untreated psychosis (DUP) in younger children, high symptom severity, high prevalence of cannabis use and a relatively young mean age of symptom onset.

The second manuscript revealed that the DUP may be influenced by other socio-cultural factors in the African setting.

The third paper reported that the family history of psychosis (FHP) was more specific among EOP adolescents than non-psychotic controls. FHP was also associated with a younger age of presentation for males only and with lower mean PANSS positive and total scores. ‘This suggests that FHP may be of diagnostic and clinical utility. However the findings are limited by the small sample size,’ said Paruk.

The final manuscript suggested that psychotic adolescents were more vulnerable to cannabis related problems than other mentally ill adolescents. It also revealed that psychotic and non-psychotic adolescents also differed in their reasons for cannabis use and in their socio-demographic profiles. 

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