Questions to ask young male patients about Psychotic Disorders

Overview

Schizophrenia spectrum and other psychotic disorders include schizophrenia, other psychotic disorders, and schizotypal (personality) disorder. They are defined by abnormalities in one or more of the following five domains: delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia) and negative symptoms.¹

Adolescents with psychosis have difficulty with thinking, behaving and communicating — and with understanding reality. These challenges can seriously impair their development and functioning. Positive symptoms include delusions and hallucinations. In contrast, negative symptoms are characterized by a loss or reduction in typical functioning and include flat affect, limited speech and diminished energy. Negative symptoms are thought to have a stronger effect on cognitive and other areas of functioning than positive symptoms.²

Of the range of these disorders, jealous delusions are probably more common in males³ than females. Hostility and aggression can be associated with schizophrenia and aggression is more common with young males.⁴ An emphasis on negative symptoms of schizophrenia and longer duration of disorder (associated with poorer outcome) shows higher incidence rates for males.⁵ The psychotic features of schizophrenia typically emerge between the late teens and the mid-30s; onset prior to adolescence is rare. The peak age an onset for the first psychotic episode in the early to mid-20s for males. The onset may be abrupt or insidious, but the majority of individuals manifest a slow and gradual development of a variety of clinically signs and symptoms. Earlier age at onset has traditionally been seen as a predictor of worse prognosis.  However, the age at onset is likely related to gender, with males having worse premorbid adjustment, lower educational achievement, more prominent negative symptoms and cognitive impairment, and in general a worse outcome.⁶ The general incidence of schizophrenia tends to be slightly lower in females, particularly among treated cases.⁷ Social functioning appears to be better preserved in females.⁸  Suicide risk remains high over the whole lifespan for males and females, although it may be especially high for younger males with comorbid substance use.⁹

A July 2013 study found that psychotic symptoms in adolescents are a clinical marker of high risk for suicide attempts, particularly in those with psychopathology.¹⁰