Developmental influences on symptom expression in antipsychotic-naïve first-episode psychosis

Miranda Bridgwater, Peter Bachman, Brenden Tervo-Clemmens, Gretchen Haas, Rebecca Hayes, Beatriz Luna, Dean F. Salisbury, Maria Jalbrzikowski

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background The neurodevelopmental model of psychosis was established over 30 years ago; however, the developmental influence on psychotic symptom expression - how age affects clinical presentation in first-episode psychosis - has not been thoroughly investigated. Methods Using generalized additive modeling, which allows for linear and non-linear functional forms of age-related change, we leveraged symptom data from a large sample of antipsychotic-naïve individuals with first-episode psychosis (N = 340, 12-40 years, 1-12 visits), collected at the University of Pittsburgh from 1990 to 2017. We examined relationships between age and severity of perceptual and non-perceptual positive symptoms and negative symptoms. We tested for age-associated effects on change in positive or negative symptom severity following baseline assessment and explored the time-varying relationship between perceptual and non-perceptual positive symptoms across adolescent development. Results Perceptual positive symptom severity significantly decreased with increasing age (F = 7.0, p = 0.0007; q = 0.003) while non-perceptual positive symptom severity increased with age (F = 4.1, p = 0.01, q = 0.02). Anhedonia severity increased with increasing age (F = 6.7, p = 0.00035; q = 0.0003), while flat affect decreased in severity with increased age (F = 9.8, p = 0.002; q = 0.006). Findings remained significant when parental SES, IQ, and illness duration were included as covariates. There were no developmental effects on change in positive or negative symptom severity (all p > 0.25). Beginning at age 18, there was a statistically significant association between severity of non-perceptual and perceptual symptoms. This relationship increased in strength throughout adulthood. Conclusions These findings suggest that as maturation proceeds, perceptual symptoms attenuate while non-perceptual symptoms are enhanced. Findings underscore how pathological brain-behavior relationships vary as a function of development.

Original languageEnglish (US)
Pages (from-to)1698-1709
Number of pages12
JournalPsychological medicine
Issue number9
StatePublished - Jul 6 2022
Externally publishedYes

Bibliographical note

Publisher Copyright:
Copyright © The Author(s), 2020. Published by Cambridge University Press.


  • Adolescence
  • age effects
  • antipsychotic-naïve
  • psychotic symptoms
  • schizophrenia


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