Association Between Nonpsychotic Psychiatric Diagnoses in Adolescent Males and Subsequent Onset of Schizophrenia

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Abstract
SEVERAL prospective longitudinal or follow-up studies suggest that some adolescents who manifest abnormal behavior or personality traits may be at high risk of manifesting mental illness as adults. Adolescents diagnosed as having personality disorders are at increased risk for anxiety, disruptive behavior, affective symptoms, and substance abuse during early adulthood,1,2 and persons with obsessive-compulsive disorder, social phobia, and panic attacks examined in the National Institute of Mental Health Epidemiologic Catchment Area study3 were at increased risk for future schizophrenia. The Minnesota Multiphasic Personality Inventory traits of depression, anxiety, internalized anger, social alienation, and withdrawal are associated with increased risk of future schizophrenia.4 Adolescents with schizotypal personality traits seem to be at a particularly high risk for future psychosis.5-8 A recent follow-up study of conscripts screened by the Swedish army found that 18-year-olds with personality disorders, neurosis, substance abuse, or alcohol abuse were at increased risk for future schizophrenia.9 Similarly, studies of persons with schizophrenia found that some future patients had subnormal intelligence, withdrawn social behavior, conduct and adjustment abnormalities, and very mild neurological deficits10-15 years before the onset of psychosis. Assessing the prevalence of nonpsychotic psychiatric disorders preceding the diagnosis of schizophrenia is important in understanding the pathophysiologic characteristics of the illness, as some authors16,17 claim that these abnormalities may reflect a neurodevelopmental origin of illness. In addition, diagnoses with relatively high rates of later hospitalization for schizophrenia might constitute part of a cluster of markers to be used in the future for the early detection of schizophrenia. Such a cluster might include impaired attention,18 a decrease in the normal inhibition of the P50 auditory-evoked response to the second of paired stimuli,19 and impaired eye tracking.20

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