Undiagnosed psychiatric illness in adolescents. A prospective study and seven-year follow-up

Twenty-four psychiatrically ill adolescents, unclassifiable by diagnostic criteria, were followed up after seven years. Fifteen had been ill in the interval, and the conditions of 12 of these could, as adults, be diagnosed according to established syndromes because atypical adolescent psychiatric disorder became more typical in adulthood. Nine subjects remained well. Their original disorders had been characterized by depressed mood, reactivity, and conflicts with parents. Such a clinical picture in the absence of drug or alcohol abuse had good prognosis. Among many clinical and sociological features present at the time of the original study, only the presence of a "psychotic" symptom (hallucinations, delusions, formal thought disorder, or bizarre behavior) differentiated those who would be sick at follow-up from those who would be well. Poor outcome was predicted by such a symptom regardless of what the diagnosis later turned out to be.