Extended Abstract
1. Introduction
First Episode Psychosis (FEP) refers to the emergence of psychotic symptoms such as delusion, hallucination, disorganized behavior, and abnormal effects before the age of 18 years. Early diagnosis and treatment of FEP have been considered as an important field of research in the past two decades, confirming the effect of early preventive strategies. Research on adults with FEP has been conducted in Iran evaluating diagnostic stability, course, and clinical consequences [5-7]; however, the different aspects of FEP in children and adolescents in Iran have seldom been evaluated. Therefore, this study was done to evaluate the demographic and clinical characteristics of inpatient children and adolescents with FEP at a tertiary psychiatric hospital.
2. Method
During a two-year prospective study (2013-2014), all consecutive admissions in the child and adolescent psychiatric ward were evaluated in terms of FEP. Among them, those whose symptoms were substance-induced or had medical etiology were excluded. The study aims and process were explained to the participants, and their parents and oral assent and consent were received from them. Diagnoses were made using clinical assessment by a child and adolescent psychiatrist and confirmed by a semi-structured interview using the Kiddie Schedule for Affective Disorder and Schizophrenia-Present and lifetime Version-Persian Version. 
The Positive and Negative Symptoms Scale (PANSS) was used by a clinician to rate the psychotic features of FEP in the participants. Moreover, to assess the participants’ adaptation before the emergence of psychosis, the Premorbid Adjustment Scale (PAS) was accomplished for interviewing the participants and their parents. The study clinician completed the Clinical Global Assessment Scale (CGAS) to rate the level of general functioning in the participants. The World Health Organization Quality of Life- brief questionnaire (WHOQOL-Bref) was completed by the participants to determine the quality of life variables. The participants were receiving treatment as per the usual protocol in the hospital. To analyze the data, the descriptive method was used to assess the prevalence and means. The Spearman’s correlation analysis was performed to test the association between the variables.
3. Results
A total of 44 participants (47.7% boys) with FEP were enrolled in the study. Their mean age was 193.11(21.5) months, and 70.5% were students. Among them, 43.2% lived in the capital and the others were referred from other states of the country. The history of psychiatric disorders was positive in 18.2% of first- and second-degree relatives of the participants. Before admission, half of the participants had visited psychiatrists, and nearly 40% had been referred to psychologists. The duration of untreated psychosis was more than 6 months in 13% of the participants while 31.2% of the youth were admitted in the first 2 weeks. In terms of psychiatric diagnoses, 68.3% were suffering from Bipolar Disorder (BD) and 15.9% from Schizophrenia. Brief psychotic disorder and psychosis not otherwise specialized were found in 4.5% and 2.3% patients, respectively. 
The most prevalent comorbid disorders were obsessive-compulsive disorder (11.3%), attention-deficit hyperactivity disorder (9%), specific phobia (6.8%), and autism (4.5%). Intellectual disability was found in 11.4%, and medical disease in one-third of the participants. More than 40% of the participants had problems approaching with mental health services. Poor adjustment before the emergence of psychosis was negatively related with academic level and positively consistent with female gender, suicidal risk, and duration of psychotic disorder (P<0.05). The level of premorbid global functioning was lower than 80% in 93% of the participants. This score was less than 40% in 95% of them during admission. Correlation coefficients between demographic characteristics and severity of psychotic symptoms (based on PANSS scores) and premorbid adjustment (based on PAS scores) in the participants (n=44)are shown in Table 1. Table 2 demonstrates correlation coefficients between quality of life, severity of psychotic symptoms, and premorbid adjustment in the participants.  4. Conclusion
This study used limited prospective cohorts of children/adolescents who experienced symptoms of an episode of psychosis for the first time. Among this group of inpatients in a psychiatric hospital, bipolar disorder was the most common diagnosis and non-affective psychotic disorders came second. This fact was in line with some previous findings while it was inconsistent with the studies that showed Schizophrenia and Schizophreniform disorders as the most common diagnoses in children and adolescents with FEP [1-4]. These different findings can be interpreted by various methods of assessment and case findings; for example, outpatient versus inpatient enrollment. 
The participants in our study suffered from severe psychiatric symptoms and risk of suicide. Appropriate mental health services were not available for many of these children and adolescents, and they were at risk of chronicity of psychosis and its lifelong negative consequences. FEP was consistent with poor premorbid adjustment and severe global functioning impairment. These findings confirm the need for early prevention for vulnerable individuals, as well as appropriate pharmacologic and non-pharmacologic interventions. 
Acknowledgments
This paper was financially supported by Tehran University of Medical Sciences (Grant Number: 10294). 
Conflict of Interest
The authors declare no conflicts of interest.