Three Distinct Pathways to First Episode Mania and Psychosis: Latent Class Analysis of Antecedent Psychopathology

IF 5 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica Pub Date : 2025-06-13 DOI:10.1111/acps.13826

Mete Ercis, Alessandro Miola, Javier Ortiz-Orendain, Vanessa K. Pazdernik, Tamahara Gonzalez-Campos, Manuel Gardea-Resendez, Peggy M. Gruhlke, Ian M. Michel, Jennifer L. Vande Voort, Alastair J. McKean, Aysegul Ozerdem, Mark A. Frye

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引用次数: 0

Abstract

Background

Despite the classic Kraepelinian dichotomy between bipolar disorder (BD) and schizophrenia (SZ), contemporary evidence suggests shared antecedent risk factors and similarities in the early course. This study aimed to identify distinct trajectories leading to first-episode mania (FEM) and first-episode psychosis (FEP) by examining antecedent psychopathology, including psychiatric diagnoses, symptoms, substance use, and psychotropic medication exposure.

Methods

Individuals born after 1985 who resided in Olmsted County, Minnesota, USA, and had FEM/FEP were identified through the Rochester Epidemiology Project. Latent class analysis (LCA) was used to identify subgroups based on antecedent psychopathology incorporating 57 dichotomous antecedent measures before FEM/FEP.

Results

A total of 202 individuals (BD n = 73, SZ n = 129; 26.7% female, mean age 20.8 ± 3.7 years) were included. A 3-class LCA model optimally fits the data. Class 1 (Neurodevelopmental, 29.7%) had a high prevalence of neurodevelopmental disorders, behavioral symptoms, and ADHD medication use. Class 2 (Depressive-Anxious, 31.2%) included depressive and anxiety disorders, mood-related symptoms, and SSRI/SNRI use. Class 3 (Minimal Psychiatric Morbidity, 39.1%) had a low prevalence of antecedent diagnoses and symptoms, with comparable substance use to other classes. There were significant diagnostic differences, with SZ being more common in the Neurodevelopmental (71.7%) and Minimal Psychiatric Morbidity (70.9%) classes, while BD was more common in the Depressive-Anxious class (p = 0.007). Neurodevelopmental and Minimal Psychiatric Morbidity classes had higher proportions of males (85.0% and 82.3%, respectively) compared to the Depressive-Anxious class (50.8%, p < 0.001). The Neurodevelopmental class showed an earlier age at first mental health visit (9.5 ± 5.5 years) and a longer antecedent illness duration (10.8 ± 6.1 years) than the other classes (p < 0.001).

Conclusion

This study identified three distinct pathways to FEM and FEP, offering a transdiagnostic perspective on the antecedent illness trajectories of BD and SZ. Future research should validate these categories that are more inclusive than the classic BD versus SZ dichotomy and explore their potential for predicting illness course and guiding personalized early interventions.

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致首发躁狂和精神病的三种不同途径：前因精神病理的潜在分类分析

背景：尽管双相情感障碍（BD）和精神分裂症（SZ）之间存在经典的kraepelian二分法，但当代证据表明它们具有共同的先前危险因素和早期病程的相似性。本研究旨在通过检查先前的精神病理学，包括精神诊断、症状、物质使用和精神药物暴露，确定导致首发躁狂（FEM）和首发精神病（FEP）的不同轨迹。方法通过罗切斯特流行病学项目对1985年以后出生、居住在美国明尼苏达州奥姆斯特德县并患有FEM/FEP的个体进行筛选。采用潜在类分析（LCA）来识别基于前因精神病理的亚组，包括FEM/FEP之前的57个二分前因测量。结果共纳入202例患者，其中BD 73例，SZ 129例，女性26.7%，平均年龄20.8±3.7岁。一个3级LCA模型最优拟合数据。1类（神经发育，29.7%）神经发育障碍、行为症状和ADHD药物使用的患病率很高。第2类（抑郁-焦虑，31.2%）包括抑郁和焦虑障碍、情绪相关症状和SSRI/SNRI使用。第3类（最低精神病发病率，39.1%）先前诊断和症状的患病率较低，与其他类别的药物使用相当。有显著的诊断差异，SZ在神经发育（71.7%）和最低精神发病率（70.9%）类别中更常见，而BD在抑郁-焦虑类别中更常见（p = 0.007）。与抑郁-焦虑类别（50.8%,p < 0.001）相比，神经发育和轻度精神疾病类别的男性比例更高（分别为85.0%和82.3%）。神经发育组患者首次心理健康访视年龄（9.5±5.5岁）较其他组早，既往病程（10.8±6.1岁）较其他组长（p < 0.001）。结论本研究确定了三条不同的FEM和FEP通路，为BD和SZ的既往疾病轨迹提供了一个跨诊断的视角。未来的研究应该验证这些比经典的双相障碍与SZ二分法更具包容性的分类，并探索它们在预测病程和指导个性化早期干预方面的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.