Abstract
This study reports on the long-term course of 11 patients (6 girls, 5 boys) with childhood onset schizophrenia (COS, age at onset < 10 years). Patients were examined twice (mean follow-up period 38 years after onset). The premorbid development is assessed in terms of the Modified Premorbid Adjustment Scale (M- PAS) and additionally described by distinct psychopathological categories. The psychopathology at the onset of psychosis and at the second follow-up examination was assessed by categorical application of the Positive and Negative Syndrome Scale (PANSS). The outcome was rated with the Disability Assessment Score (DAS). The course of psychotic episodes and intervals between them is presented according to DSM-IV subtype classifications. Ten of 11 patients presented premorbid developmental peculiarities that were not adequately covered by the M-PAS subscales. Whereas in the 4 patients with acute onset of psychosis the positive PANSS-type was predominant, in the 7 patients with an insidious onset the negative PANSS-type prevailed. The nature of the diagnostic subtypes varied markedly across the course of the illness. In case of a continuous predominant catatonic symptomatology the outcome was poor. Detailed case descriptions help to illuminate the heterogeneous psychopathology of COS. Various temporary premorbid behavioral peculiarities were precursors of COS. A differentiation between premorbid and prodromal signs proved to be arbitrary. Our results contradict the assumption that COS is characterized only by a negative symptomatology.
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REFERENCES
Alaghband-Rad, J., McKenna, K., Gordon, C., Albus, K., Hamburger, S., Rumsey, J., Frazier, J., Lenane, M., & Rapoport, J. M. (1995). Childhood-onset schizophrenia: The severity of premorbid course. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1273-1283.
American Psychiatric Association, (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Andreasen, N. C. (1997). The evolving concept of schizophrenia: from Kraeplin to the present and future. Schizophrenia Research, 28, 105-109.
Asarnow, J. R. (1994). Childhood-onset schizophrenia. Journal of Child Psychology and Psychiatry, 35, 1345-1371.
Asarnow, J. R., & Ben-Meir, S. (1988). Children with schizophrenia spectrum and depressive disorders: A comparative study of onset patterns, pre-morbid adjustment and severity of dysfunction. Journal of Child Psychology and Psychiatry, 29, 477-488.
Asarnow, J. R., Thompson, M. C., & Goldstein, M. J. (1994). Childhood-onset Schizophrenia: A follow-up study. Schizophrenia Bulletin, 20, 599-617.
Asarnow, R. F., Brown, W., & Strandburg, R. (1995). Children with a schizophrenic disorder: Neurobehavioral studies. European Archives of Psychiatry and Clinical Neuroscience, 245, 70-79.
Barnes, T. R. E. (1994). Issues in the clinical assessment of negative symptoms. Current Opinion Psychiatry, 7, 35-38.
Bleuler, M. (1978). The schizophrenic disorders: Long term patient and family studies. New Haven, CT: Yale University.
Bunk, D., & Eggers, C. (1990). The Course of juvenile schizoaffective and schizophrenic psychoses: The use of pattern analysis for classifying the development of schizophrenia-like Illnesses. In A. Maneros, & M. Tsuang (Eds.), Affective and schizoaffective disorders: Similarities and differences (pp. 89-101). Berlin: Springer.
Cannon-Spoor, H. E., Potkin, S. G., & Wyatt, R. Y. (1982). Measurement of pre-morbid adjustment in chronic schizophrenia. Schizophrenia Bulletin, 8, 470-484.
Cantor, S. (1982). The schizophrenic child. Montreal: Eden.
Crow, T. J., Done, D. J., & Sacker, A. (1995). Childhood precursors of psychosis as clues to its evolutionary origins. European Archives of Psychiatry and Clinical Neuroscience, 245, 61-69.
Eggers, C. (1973). Verlaufweisen kindlicher und präpuberaler Schizophrenien. Monogrpahien aus dem Gesamtgebiete der Psychiatric (Bd. 9). Berlin: Springer.
Eggers, C. (1978). Course and prognosis in childhood schizophrenia. Journal of Autism and Childhood Schizophrenia, 8, 21-36.
Eggers, C., & Bunk, D. (1997). The long-term course of childhood onset schizophrenia. Schizophrenia Bulletin, 23, 83-92.
Foerster, A., Lewis, S. H., Owen, M., & Murray, R. (1991). Pre-morbid adjustment and personality in psychosis. British Journal of Psychiatry, 158, 171-176.
Gartner, J., Weintraub, S., & Carlson, G. A. (1997). Childhood-onset psychosis: Evolution and comorbidity. American Journal of Psychiatry, 154, 256-261.
Goodman, R., Yule, C., Richards, H., & Taylor, E. (1996). Rating child psychiatric caseness from detailed case histories. Journal of Child Psychology and Psychiatry, 37, 369-379.
Green, W. H., Padron-Gayol, M., Hardesty, A. S., & Bassiri, M. (1992). Schizophrenia with childhood onset: A phenomenological study of 38 cases. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 968-976.
Häfner, H., Riecher-Rössler, A., & Hambrecht, M. (1992). IRAOS: An Instrument for the assessment of the onset and early course of schizophrenia. Schizophrenia Research, 6, 209-223.
Hollis, C. P. (1994). Developmental language impairment in child and adolescent-onset schizophrenia. Schizophrenia Research, 11, 183-184.
Hollis, C. P. (1995). Child and adolescent (juvenile onset) schizophrenia. A case control study of pre-morbid developmental impairments. British Journal of Psychiatry, 166, 489-495.
Jablensky, A. (1997). The 100-year epidemiology of schizophrenia. Schizophrenia Research, 28, 111-125.
Jung, E., Krumm, B., Biehl, H., Maurer, K., & Bauer-Schubart, C. (1989). Mannheimer Skala zur Einschätzung sozialer Behinderung, DAS-M. Weinheim, Germany: Beltz Test.
Kay, S. R., Opler, A., & Fiszbein, A. (1986). Positive and Negative Syndrome Scale (PANSS). New York: Department of Psychiatry, Albert Einstein College of Medicine-Montefiore Medical Center and Schizophrenia Research Unit.
Kolvin, I. (1971). Studies in childhood psychoses: I. Diagnostic criteria and classification. British Journal of Psychiatry, 118, 381-384.
Matsumoto, H. (1996). Clinical study of childhood schizophrenia. In M. Shimizu (Ed.), Recent progress in child and adolescent psychiatry. Tokyo: Springer.
Mattanah, J. J. F., Becker, D. F., Levy, K. N., Edell, W. S., & McGlashan, T. H. (1995). Diagnostic stability in adolescents followed up 2 years after hospitalization. American Journal of Psychiatry, 152, 889-894.
Maziade, M., Gingras, N., & Rodrigue, C. (1996). Long-term stability of diagnoses and symptom dimensions in a systematic sample of patients with onset of schizophrenia in childhood and early adolescence. I: Nosology, sex and age of onset. British Journal of Psychiatry, 169, 361-370.
McClellan, J. M., & Werry, J. S. (1994). Practice parameters for assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 616-635.
McClellan, J. M., Werry, J. S., & Ham, M. (1993). A follow-up study of early onset psychosis: Comparison between outcome diagnoses of schizophrenia, mood disorders, and personality disorders. Journal of Autism and Developmental Disorders, 23, 243-262.
Peralta, V., Cuesta, M. J., & De Leon, J. (1995). Positive and negative symptoms/syndromes in schizophrenia: Reliability and validity of different diagnostic systems. Psychological Medicine, 25, 43-50.
Russell, A. T. (1994). The clinical presentation of childhood-onset schizophrenia. Schizophrenia Bulletin, 20, 631-646.
Russell, A. T., Bott, L., & Sammons, C. (1989). The phenomenology of schizophrenia occurring in childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 399-407.
Rutter, M. (1972). Childhood schizophrenia reconsidered. Journal of Autism and Childhood Schizophrenia, 2, 315-337.
Schneider, K. (1962). Klinische Psychopathologie. Stuttgart: Thieme.
Shepherd, M., Watt, D., Falloon, I., & Smeeton, N. (1989). The natural history of schizophrenia: A five-year follow-up study of outcome and prediction in a representative sample of schizophrenics. In M. Shepherd (Ed.), Psychological medicine (Monograph Suppl. 15). Cambridge, UK: Cambridge University Press.
Volkmar, F. R. (1996). Childhood and adolescent psychosis: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 843-851.
Watkins, J. M., Asarnow, R. F., & Tanguay, P. E. (1988). Symptom development in childhood onset schizophrenia. Journal of Child Psychology and Psychiatry, 29, 865-878.
Werry, J. S. (1992). Child and adolescent (early onset) schizophrenia: A review in light of DSM-III-R. Journal of Autism and Developmental Disorders, 22, 601-624.
Werry, J. S., & McClellan, J. M. (1992). Predicting outcome in child and adolescent (early onset) schizophrenia and bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 147-150.
Werry, J. S., McClellan, J. M., & Chard, L. (1991). Childhood and adolescent schizophrenia, bipolar, and schizoaffective disorders: A clinical and outcome study. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 457-465.
Wing, J. K., Cooper, J. E., & Sartorius, N. (1974). The Description and classification of psychiatric symptoms: An instruction manual for the PSE and CATEGO system. London: Cambridge University Press.
World Health Organization. (1993). The ICD-10 classification of mental and behavioral disorders. Geneva: Author.
Zerssen, D. von, (1996). Forschungen zur prämorbiden Persönlichkeit in der Psychiatrie der deutssprachigen Länder: Die letzten drei Jahrzehnte. Fortschrift für Neurologie und Psychiatrie, 64, 168-173.
Zerssen, D. von (1997): Der biographische Ansatz in der psychiatrischen Forschung. Fundamenta Psychiatrica, 11, 48-53.
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Eggers, C., Bunk, D. & Krause, D. Schizophrenia with Onset Before the Age of Eleven: Clinical Characteristics of Onset and Course. J Autism Dev Disord 30, 29–38 (2000). https://doi.org/10.1023/A:1005408010797
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DOI: https://doi.org/10.1023/A:1005408010797