IQ Decline in Childhood May Portend Psychosis in Adulthood

Emerging research suggests declines in IQ during early childhood and adolescence can lead to psychotic episodes in adulthood. Investigators theorize that declining IQ causes children and young adults to fall progressively behind their peers across a range of cognitive abilities.

Researchers from King’s College London’s Institute of Psychiatry, Psychology & Neuroscience (IoPPN), and Icahn School of Medicine at Mount Sinai in the United States believe educational interventions could potentially delay the onset of mental illness.

Psychotic disorders, such as schizophrenia, are severe mental illnesses affecting one to three percent of the population cause a range of abnormalities in perception and thinking. The study is the first to track IQ scores and cognitive abilities throughout the entire first two decades of life among individuals who develop psychotic disorders in adulthood.

“’For individuals with psychotic disorders, cognitive decline does not just begin in adulthood, when individuals start to experience symptoms such as hallucinations and delusions, but rather many years prior, when difficulties with intellectual tasks first emerge, and worsen over time. Our results suggest that among adults with a psychotic disorder, the first signs of cognitive decline are apparent as early as age four,” said Dr. Josephine Mollon.

The study appears in JAMA Psychiatry.

Previous studies have shown that deficits in IQ begin many years before hallucinations and delusions first appear in patients with psychotic disorders, but the timing of when these IQ deficits emerge has not been clear.

The new study provides the clearest evidence to date of early life cognitive decline in individuals with psychotic disorders.

The study included 4,322 U.K.-based individuals who were followed from 18 months to 20 years old. Those who developed psychotic disorders as adults had normal IQ scores in infancy, but by age four their IQ started to decline, and continued to drop throughout childhood, adolescence and early adulthood until they were an average of 15 points lower than their healthy peers.

As well as falling behind in IQ, individuals who developed psychotic disorders lagged increasingly behind their peers in cognitive abilities such as working memory, processing speed, and attention.

IQ scores fluctuate among healthy individuals, and not all children struggling at school are at risk of developing serious psychiatric disorders.

“It is important to bear in mind that many children will experience some difficulties with schoolwork or other intellectual tasks at some point in their lives, and only a small minority will go on to develop a psychotic disorder,” said senior author Dr. Abraham Reichenberg.

The results suggest that adults who develop psychotic disorders do not go through a deterioration in cognitive function, but instead they fail to keep up with normal developmental processes. Early interventions to improve cognitive abilities may potentially help stave off psychotic symptoms from developing in later life.

“There are early interventions offered to adolescents and young adults with psychosis,” said Reichenberg. “Our results show the potential importance of interventions happening much earlier in life. Intervening in childhood or early adolescence may prevent cognitive abilities from worsening and this may even delay or prevent illness onset.”

The researchers are now examining changes in the brains of individuals who go on to develop psychotic disorders, as well as potential environmental and genetic risk factors that may predispose individuals to poor cognition.

Source: King’s College London/EurekAlert

Study Finds Kids are Not Overmedicated

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A new study suggests that contrary to popular opinion, psychiatric medications are not overprescribed for American kids. In fact, because of limited access to child psychiatrists, researchers worry more about undertreatment and a failure to explore other means of treatments before medications.

Investigators from Columbia University Irving Medical Center (CUIMC) compared prescribing rates with prevalence rates for the most common psychiatric disorders in children, and discovered that some of these medications may be underprescribed.

“Over the last several years, there has been widespread public and professional concern over reports that psychiatric medications are being overprescribed to children and adolescents in the United States,” said Ryan Sultan, M.D., a child psychiatrist and researcher at CUIMC who led the study.

“We were interested in better understanding this concern.”

The research findings appear online in the Journal of Child and Adolescent Psychopharmacology.

Investigators used data from a national prescription database of 6.3 million children between the ages of three and 24 years. They, and reviewed the annual prescriptions for three psychiatric drug classes: stimulants, antidepressants, and antipsychotics.

They then compared prescribing patterns with known prevalence rates of attention deficit-hyperactivity disorder (ADHD), anxiety disorders, and depression between young children (three to five years), older children (six to 12 years), adolescents (13 to 18 years), and young adults (19 to 24 years).

This is the first national study to analyze prescription rates for these three types of psychiatric medications in youth.

Annually, an estimated one in eight U.S. teenagers has a depressive episode, and roughly one in 12 children have symptoms of ADHD. During the year studied, fewer than one in 30 teenagers received a prescription for antidepressants, and only one in 20 got a prescription for stimulants.

“Our results show that, at a population level, prescriptions of stimulants and antidepressant medications for children and adolescents do not appear to be prescribed at rates higher than the known rates for psychiatric conditions they are designed to treat,” said Sultan.

“These findings are inconsistent with the perception that children and adolescents are being overprescribed.”

Overall psychiatric drug prescription patterns in children and adolescents children in the youngest group accounted for the smallest number (0.8 percent) of prescriptions for any psychiatric drug. Adolescents accounted for the highest number (7.7 percent).

The number of prescriptions for stimulants was highest in older children (4.6 percent), with males accounting for more of these prescriptions than females. Antidepressant prescriptions increased with age and was highest for young adults (4.8 percent), particularly for females. Antipsychotic prescriptions peaked during adolescence (1.2 percent) and were prescribed slightly more often for males in this age group.

“The study also showed that, among young people in the United States, the patterns of prescriptions for antidepressants and stimulants are broadly consistent with the typical ages associated with the onsets of common mental disorders, said Mark Olfson, M.D., professor of psychiatry at CUIMC and senior author of the paper.

“However, the situation with antipsychotic medications is less clear cut. Given clinical uncertainty over their appropriate indications, it is unclear whether their annual use rates, which ranged from 0.1 percent in younger children to 1 percent in adolescents, are above or below the rates of the psychiatric disorders they aim to treat.”

“These results provide some reassurance to those who are concerned about the overprescribing of psychiatric medications to children and teenagers,” said Sultan.

“Improving access to child psychiatrists through consultation services and collaborative care models may help address potential undertreatment while also reducing the risk of prescribing medications before other treatments have been tried.”

Source: Columbia University/EurekAlert