Age of onset of mental disorders : etiopathogenetic and treatment implications

This book presents a thorough and critical review of current knowledge about the age of onset of mental disorders. The opening chapters offer information about the impact of the age of onset on the clinical picture, course, and outcome of physical illnesses, and about the neurobiological implications and correlates of different ages of onset. The impact and correlates of the ages of onset of all the most important mental disorders are then discussed in detail by internationally renowned scientists. The background to the book is the recognition that a better understanding of age of onset makes it possible to estimate the lifetime risk of disorders, helps to elucidate pathogenesis, and facilitates efficient, targeted clinical management. The book will be of value for clinicians, mental health professionals, mental health researchers, epidemiologists, and different stakeholders in the mental health field. Foreword 5 Contents 11 Contributors 13 1: Introduction: Relevance of the Age of Onset of Mental Disorders to Research in Psychiatry and to the Organization of Services for People with Mental Illness 17 1.1 Introduction 17 1.2 Age, Development and Diseases 18 1.3 Options for the Definition of the Age of Onset: Their Advantages and Disadvantages 19 1.3.1 Criterion 1: The Age When the First Morpho-functional Pathological Processes, Which Lead to a Disorder (e.g. Cellular, Receptor or Genetic Alterations or Changes), Appear 19 1.3.2 Criterion 2: The Age When the First Signs of a Disorder Appear (e.g. Cognitive Dysfunctions) 20 1.3.3 Criterion 3: The Age When the First Symptoms of a Disorder Appear (e.g. Depressed Mood) 21 1.3.4 Criterion 4: The Age When the First Overt Episode of a Disorder Appears (e.g. First Psychotic Episode) 22 1.3.5 Criterion 5: The Age of the First Contact with Any Health Service 23 1.3.6 Criterion 6: The Age of the First Pharmacological Treatment 23 1.3.7 Criterion 7: The Age of the First Hospitalization 24 1.4 Methods for Assessing the Age of Onset, Their Advantages and Shortcomings 24 1.5 Clinical Consequences of Different AOO 26 1.6 Public Health Consequences of Different AOO 26 1.7 Plan of the Book 27 References 28 2: Lessons from Knowledge on the Correlates of the Age of Onset of Physical Illness 30 2.1 Models of Environmental Influences 31 2.1.1 Cumulative Exposure Model: The Example of Lung Cancer and Smoking 31 2.1.2 Susceptibility Windows: Breast Cancer and Relevance of Exposure at Puberty 33 2.1.3 Developmental Origin of Health and Disease Hypothesis (DOHAD): The Case of Early Socioeconomic Status and Diabetes 34 2.1.3.1 Examples from Recent Research 35 2.1.4 Epigenetic Age Acceleration 36 2.1.4.1 Association of Age Acceleration with Unhealthy Lifestyle and Ageing-Related Diseases 37 2.1.4.2 Epigenetic Clock in Newborns and Children 38 2.1.4.3 Reversibility of the Effect 39 References 39 3: Does the Age of Onset Shape the Clinical Picture, Course and Consequences of Schizophrenia? Results from a Long-Term Epidemiological Study 44 3.1 Introduction 44 3.2 Age of Onset (AOO) as a Disorder Marker 45 3.3 Early- and Late-Onset Schizophrenia: Are They the Same Disorder? 47 3.4 The ABC Study 49 3.5 Childhood- and Early-Onset Schizophrenia 50 3.6 Sex Difference in AOO of Schizophrenia 51 3.6.1 Search for the Causes of Sex Difference in the AOO of Schizophrenia 54 3.7 AOO and the Clinical Picture of Schizophrenia 57 3.8 AOO and Other Variables Shaping the Course of Schizophrenia 62 3.8.1 Clinical and Social Aspects of Late- and Very-Late-Onset Schizophrenia 63 References 65 4: The Age of Onset of Schizophrenia Spectrum Disorders 70 4.1 Introduction 70 4.2 Incidence by Age and Sex 72 4.3 Risk Factors for Early Onset 74 4.3.1 Genetic Influence and Family History 74 4.3.2 Early Risk Factors 74 4.3.3 Premorbid Factors 74 4.4 Age of Onset (AOO) and Outcome 75 4.5 AOO and Cognition 78 4.6 AOO and Brain Morphometry 79 4.7 AOO and Mortality 80 4.8 Discussion 81 References 83 5: The Age of Onset of Bipolar Disorders 89 5.1 Introduction 89 5.2 Methods 91 5.2.1 Searches 91 5.2.2 Inclusion and Exclusion Criteria 91 5.2.3 Data Extraction 92 5.2.4 Assessment of Strength of Reporting 92 5.2.5 Meta-analysis 93 5.3 Results 93 5.3.1 Searches and Data Extraction 93 5.3.2 Average AoO 93 5.3.3 International Differences 95 5.3.4 Family History 97 5.3.5 Comparison of Type I Versus Type II BD 97 5.3.6 Cyclothymia 98 5.3.7 Sex Differences 98 5.3.8 Current Age, Publication Year, Polarity of Onset, and Definitions of AoO 98 5.3.9 Strength of Reporting 99 5.4 Discussion 100 5.4.1 General Considerations 100 5.4.2 Clinical Implications 101 5.4.3 Strengths and Limitations 102 Appendix 103 References 111 6: The Age of Onset of Unipolar Depression 125 6.1 Age of Onset in the Scope of Major Depressive Disorder 125 6.2 Age of Onset-Specific Symptomatology and Clinical Outcomes in Major Depressive Disorder 127 6.3 Age of Onset-Specific Aetiology of Major Depressive Disorder 130 6.4 Age of Onset of Major Depressive Disorder and Brain Imaging 131 6.5 Age of Onset of Major Depressive Disorder and Conversion to Bipolar Disorder 131 6.6 Late-Onset Major Depressive Disorder and Cognitive Impairment 132 6.7 Age-Specific Treatment Recommendations for Major Depressive Disorder 133 References 135 7: The Age of Onset of Anxiety Disorders 139 7.1 Introduction 139 7.2 Methods 141 7.3 Age of Onset of Anxiety Disorders 142 7.3.1 Anxiety Disorders in General 142 7.3.1.1 Between-Study Heterogeneity and Publication Bias 142 7.3.1.2 Meta-Regressions 142 7.3.2 Separation Anxiety Disorder 143 7.3.3 Specific Phobia 145 7.3.4 Social Phobia 145 7.3.5 Agoraphobia Without Panic Disorder 149 7.3.6 Obsessive–Compulsive Disorder 149 7.3.7 Post-Traumatic Stress Disorder 152 7.3.8 Panic Disorder 152 7.3.9 Generalized Anxiety Disorder 152 7.4 Discussion 156 References 158 8: The Age of Onset of Substance Use Disorders 162 8.1 Introduction 162 8.2 The Effects and Prevalence of Illicit Drug Use in Young People 164 8.3 When Does Illicit Drug Use Typically Start? 166 8.4 Age of Onset and Drug-Related Consequences 167 8.5 Why Do Young People Initiate Illicit Drug Use? 168 8.5.1 The Gateway Hypothesis 168 8.5.2 Opportunity to Use Illicit Drugs 169 8.5.3 Person-Centred Vulnerabilities 169 8.5.4 Developmental Vulnerabilities 170 8.5.5 Social Systems Models 171 8.5.6 Transactional Models 172 8.5.7 Summary and Integration 172 8.6 Implications for Prevention of Illicit Drug Use 173 References 175 9: The Age of Onset of Alcohol Use Disorders 181 9.1 Introduction 181 9.2 Age of Onset of Alcohol Initiation 183 9.3 Age of Onset of Alcohol Intoxication and Regular Drinking 185 9.4 Age of Onset of Alcohol Use Disorder 186 9.5 Potential Clinical Utility 188 9.6 Possible Applications in Prevention 189 9.7 Policy Levers 189 References 190 10: The Age of Onset of Personality Disorders 195 10.1 Personality and Personality Disorder 195 10.2 Personality Disorders 196 10.3 Prevalence Among Adults and Young People 197 10.4 Temperament, Personality, and Personality Disorder 198 10.5 Normal Versus Maladaptive Personality Traits over the Life Course 198 10.6 Temporal Stability of Personality Disorder 199 10.7 Functional Impairment 201 10.8 Risk Factors, Precursor Signs and Symptoms 202 10.9 Personality Disorder Begins in Childhood and Adolescence 204 10.10 Implications for Prevention and Early Intervention 206 References 207 11: The Age of Onset of Eating Disorders 214 11.1 Introduction 214 11.2 Prevalence and Incidence of Eating Disorders (EDs) 215 11.2.1 Transdiagnostic “Migration” Due to DSM-5 216 11.2.2 Aetiopathogenetic Pathways and Age of Onset (AOO) Definitions in EDs 217 11.3 AOO of EDs in a Large Italian Sample 218 11.3.1 DSM-5 Diagnostic Criteria and Their Implications for the AOO in the Italian Sample 221 11.4 AOO in Other Large Samples of EDs 223 11.5 Prognostic Implications of the AOO in EDs 224 References 225 12: The Age of Onset of Attention-Deficit Hyperactivity Disorder 228 12.1 The Age of Onset of Attention Deficit Hyperactivity Disorder 228 12.1.1 A Historical Perspective 229 12.1.2 How Early in Life Can We Diagnose ADHD? 231 12.2 Defining and Refining the AOO Criteria for ADHD 233 12.2.1 Into the Present: Changes to the AOO Criterion in DSM-5 235 12.3 Can ADHD Onset in Adulthood? 237 12.4 Conclusions and Clinical Relevance 242 References 243 13: The Age of Onset of Dementias 248 13.1 Introduction 248 13.2 Methods 251 13.2.1 Illness–Death Model 251 13.2.2 Age of Onset (AOO) of a Chronic Disease 254 13.2.3 Age Distributions 255 13.2.4 Rates for the Illness–Death Model 256 13.3 Results 257 13.3.1 Estimated AOO of Dementia in Three Countries 257 13.3.2 Differences in AOO of Dementia Over Time 257 13.4 Discussion 261 References 262 14: Conclusions: From the Study of the Age of Onset to the Development of Age-Specific Interventions in Mental Health 265 14.1 Overview and Implications of Age of Onset 265 14.2 Access and Timing of Treatment 266 14.3 Prevention Strategies 268 References 269 Front Matter ....Pages i-xvi Introduction: Relevance of the Age of Onset of Mental Disorders to Research in Psychiatry and to the Organization of Services for People with Mental Illness (Giovanni de Girolamo, Patrick D. McGorry, Norman Sartorius)....Pages 1-13 Lessons from Knowledge on the Correlates of the Age of Onset of Physical Illness (Giovanni Fiorito, Carlotta Sacerdote, Paolo Vineis)....Pages 15-28 Does the Age of Onset Shape the Clinical Picture, Course and Consequences of Schizophrenia? Results from a Long-Term Epidemiological Study (Heinz Häfner)....Pages 29-54 The Age of Onset of Schizophrenia Spectrum Disorders (Jouko Miettunen, Johanna Immonen, John J. McGrath, Matti Isohanni, Erika Jääskeläinen)....Pages 55-73 The Age of Onset of Bipolar Disorders (Jessica Dagani, Ross J. Baldessarini, Giulia Signorini, Olav Nielssen, Giovanni de Girolamo, Matthew Large)....Pages 75-110 The Age of Onset of Unipolar Depression (Nefize Yalin, Allan H. Young)....Pages 111-124 The Age of Onset of Anxiety Disorders (Jeroen S. Legerstee, Bram Dierckx, Elisabeth M. W. J. Utens, Frank C. Verhulst, Carola Zieldorff, Gwen C. Dieleman et al.)....Pages 125-147 The Age of Onset of Substance Use Disorders (Adrian B. Kelly, Megan Weier, Wayne D. Hall)....Pages 149-167 The Age of Onset of Alcohol Use Disorders (Jason P. Connor, Megan Weier, Wayne D. Hall)....Pages 169-182 The Age of Onset of Personality Disorders (Andrew M. Chanen, Katherine N. Thompson)....Pages 183-201 The Age of Onset of Eating Disorders (Angela Favaro, Paolo Busetto, Enrico Collantoni, Paolo Santonastaso)....Pages 203-216 The Age of Onset of Attention-Deficit Hyperactivity Disorder (David Coghill, Phillip Asherson, Stephen V. Faraone, Luis A. Rohde)....Pages 217-236 The Age of Onset of Dementias (Sandra Landwehr, Ralph Brinks, Annika Hoyer)....Pages 237-253 Conclusions: From the Study of the Age of Onset to the Development of Age-Specific Interventions in Mental Health (Patrick D. McGorry, Norman Sartorius, Giovanni de Girolamo)....Pages 255-261