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Kottaram A, Johnston LA, Tian Y, Ganella EP, Laskaris L, Cocchi L, McGorry P, Pantelis C, Kotagiri R, Cropley V, Zalesky A. Predicting individual improvement in schizophrenia symptom severity at 1-year follow-up: Comparison of connectomic, structural, and clinical predictors. Hum Brain Mapp 2020; 41:3342-3357. [PMID: 32469448 PMCID: PMC7375115 DOI: 10.1002/hbm.25020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 01/13/2020] [Accepted: 04/13/2020] [Indexed: 12/25/2022] Open
Abstract
In a machine learning setting, this study aims to compare the prognostic utility of connectomic, brain structural, and clinical/demographic predictors of individual change in symptom severity in individuals with schizophrenia. Symptom severity at baseline and 1-year follow-up was assessed in 30 individuals with a schizophrenia-spectrum disorder using the Brief Psychiatric Rating Scale. Structural and functional neuroimaging was acquired in all individuals at baseline. Machine learning classifiers were trained to predict whether individuals improved or worsened with respect to positive, negative, and overall symptom severity. Classifiers were trained using various combinations of predictors, including regional cortical thickness and gray matter volume, static and dynamic resting-state connectivity, and/or baseline clinical and demographic variables. Relative change in overall symptom severity between baseline and 1-year follow-up varied markedly among individuals (interquartile range: 55%). Dynamic resting-state connectivity measured within the default-mode network was the most accurate single predictor of change in positive (accuracy: 87%), negative (83%), and overall symptom severity (77%) at follow-up. Incorporating predictors based on regional cortical thickness, gray matter volume, and baseline clinical variables did not markedly improve prediction accuracy and the prognostic utility of these predictors in isolation was moderate (<70%). Worsening negative symptoms at 1-year follow-up were predicted by hyper-connectivity and hypo-dynamism within the default-mode network at baseline assessment, while hypo-connectivity and hyper-dynamism predicted worsening positive symptoms. Given the modest sample size investigated, we recommend giving precedence to the relative ranking of the predictors investigated in this study, rather than the prediction accuracy estimates.
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Affiliation(s)
- Akhil Kottaram
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leigh A Johnston
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Brain Centre Imaging Unit, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ye Tian
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Eleni P Ganella
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Cooperative Research Centre for Mental Health, Carlton, Victoria, Australia
| | - Liliana Laskaris
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Neural Engineering, Department of Electrical and Electronic Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Luca Cocchi
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Patrick McGorry
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Cooperative Research Centre for Mental Health, Carlton, Victoria, Australia.,Centre for Neural Engineering, Department of Electrical and Electronic Engineering, The University of Melbourne, Melbourne, Victoria, Australia.,North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia.,Florey Institute for Neurosciences and Mental Health, Parkville, Victoria, Australia
| | - Ramamohanarao Kotagiri
- Department of Computing and Information Systems, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Hawthorn, Victoria, Australia
| | - Andrew Zalesky
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Victoria, Australia
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2
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Díaz-Caneja CM, Pina-Camacho L, Rodríguez-Quiroga A, Fraguas D, Parellada M, Arango C. Predictors of outcome in early-onset psychosis: a systematic review. NPJ SCHIZOPHRENIA 2015; 1:14005. [PMID: 27336027 PMCID: PMC4849440 DOI: 10.1038/npjschz.2014.5] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 01/31/2023]
Abstract
Given the global burden of psychotic disorders, the identification of patients with early-onset psychosis (EOP; that is, onset before the age of 18) at higher risk of adverse outcome should be a priority. A systematic search of Pubmed, Embase, and PsycInfo (1980 through August 2014) was performed to identify longitudinal observational studies assessing correlates and/or predictors of clinical, functional, cognitive, and biological outcomes in EOP. Seventy-five studies were included in the review. Using multivariate models, the most replicated predictors of worse clinical, functional, cognitive, and biological outcomes in EOP were premorbid difficulties and symptom severity (especially of negative symptoms) at baseline. Longer duration of untreated psychosis (DUP) predicted worse clinical, functional, and cognitive outcomes. Higher risk of attempting suicide was predicted by greater severity of psychotic illness and of depressive symptoms at the first episode of psychosis. Age at onset and sex were not found to be relevant predictors of outcome in most multivariate models, whereas studies using bivariate analyses yielded inconsistent results. Lower intelligence quotient at baseline predicted lower insight at follow-up, worse functional outcomes, and a diagnostic outcome of schizophrenia. Biological predictors of outcome in EOP have been little studied and have not been replicated. Lower levels of antioxidants at baseline predicted greater brain volume changes and worse cognitive functioning at follow-up, whereas neuroimaging markers such as regional cortical thickness and gray matter volume at baseline predicted remission and better insight at follow-up, respectively. EOP patients with poorer premorbid adjustment and prominent negative symptoms at initial presentation are at risk of poor outcome. They should therefore be the target of careful monitoring and more intensive interventions to address whether the disease course can be modified in this especially severely affected group. Early intervention strategies to reduce DUP may also improve outcome in EOP.
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Affiliation(s)
- Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - Laura Pina-Camacho
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | - Alberto Rodríguez-Quiroga
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - David Fraguas
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
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3
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Abstract
AIM Early-onset schizophrenia (onset before adulthood) is a rare and severe form of the disorder that shows phenotypic and neurobiological continuity with adult-onset schizophrenia. Here, we provide a synthesis of keynote findings in this enriched population to understand better the neurobiology and pathophysiology of early-onset schizophrenia. METHODS A synthetic and integrative approach is applied to review studies stemming from epidemiology, phenomenology, cognition, genetics and neuroimaging data. We provide conclusions and future directions of research on early-onset schizophrenia. RESULTS Childhood and adolescent-onset schizophrenia is associated with severe clinical course, greater rates of premorbid abnormalities, poor psychosocial functioning and increased severity of brain abnormalities. Early-onset cases show similar neurobiological correlates and phenotypic deficits to adult-onset schizophrenia, but show worse long-term psychopathological outcome. Emerging technological advances have provided important insights into the genomic architecture of early-onset schizophrenia, suggesting that some genetic variations may occur more frequently and at a higher rate in young-onset than adult-onset cases. CONCLUSIONS Clinical, cognitive, genetic and imaging data suggest increased severity in early-onset schizophrenia. Studying younger-onset cases can provide useful insights into the neurobiological mechanisms of schizophrenia and the complexity of gene-environment interactions leading to the emergence of this debilitating disorder.
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Affiliation(s)
- Nora S Vyas
- Child Psychiatry Branch, National Institute of Mental Health, NIH, Bethesda, Maryland, USA.
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4
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Thomsen PH. Child and adolescent psychiatric inpatients in Denmark Demographic and diagnostic characteristics of children and adolescents admitted from 1970 to 1986. A register-based study. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/08039489009096575] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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5
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Mother-child dynamics in early-onset depression and childhood schizophrenia spectrum disorders. Dev Psychopathol 2008. [DOI: 10.1017/s0954579400000602] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractFamily interaction patterns were compared for children with depressive disorders and children with schizophrenia spectrum disorders (SSD). Results indicated that compared to SSD children, depressed children were less positive and more negative when interacting with their mothers. Additionally, depressed children did not significantly reciprocate positive or negative statements initiated by their mothers, whereas reciprocity of both positiveness and negativeness was a significant characteristic of the SSD children. While no between group differences were found in the base rates of mothers' positive and negative responses, mothers of SSD children were more likely than mothers of depressed children to reciprocate child negativeness. Maternal reciprocity of positive statements, while not discriminating diagnostic groups, was a significant characteristic only of mothers of depressed children. The implications of these results for theories of developmental psychopathology are discussed.
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6
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Meyers K, Hagan TA, McDermott P, Webb A, Randall M, Frantz J. Factor structure of the Comprehensive Adolescent Severity Inventory (CASI): results of reliability, validity, and generalizability analyses. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2006; 32:287-310. [PMID: 16864465 DOI: 10.1080/00952990500479464] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article describes the results of psychometric work conducted on the Comprehensive Adolescent Severity Inventory (CASI) among 205 in-treatment substance-abusing adolescents. Four dimensions, each composed of component subscales, resulted from standard psychometric analyses: Chemical Dependency, Psychosocial Functioning, Delinquency, and Risk Behavior. Each dimension had high internal consistency (alpha coefficients for the component subscales comprising each clinical dimension range from .78 to .96) and test-retest reliability (intraclass correlation coefficients range from .88 to .96 and all are significant at p < .0001.). Concurrent validity and specificity of the CASI dimensions also were found: significant and substantial variance in NIMH Diagnostic Interview Schedule for Children-Revised (DISC-IV) and Brief Symptom Inventory (BSI) scores was associated with relevant CASI dimensions; CASI dimensions that theoretically should show no significant relationship with divergent pathology were not associated. The dimensions forecasted substantial variance in adolescent functioning posttreatment discharge, supporting predictive validity. Finally, the dimensional clinical structure was found to be generalizable over male and female adolescents, younger and older adolescents, and adolescents from different ethnic groups. These results provide further evidence for the CASI's promise in research and practice as an adolescent-specific assessment instrument that comprehensively assesses multidimensional areas of functioning within a developmental context of measurement. Limitations of the study along with future work currently being conducted on the CASI are discussed.
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Affiliation(s)
- Kathleen Meyers
- University of Pennsylvania School of Medicine, Department of Psychiatry, Center for Treatment and Evaluation, Philadelphia, Pennsylvania, USA.
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7
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Bursztejn C. A esquizofrenia ao longo da infância. REVISTA LATINOAMERICANA DE PSICOPATOLOGIA FUNDAMENTAL 2005. [DOI: 10.1590/1415-47142005003003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As pesquisas sobre os grupos “de alto risco” (filhos de pais esquizofrênicos), assim como os estudos prospectivos na população geral, mostram que os futuros esquizofrênicos apresentam, comparativamente aos sujeitos-controle, atrasos do desenvolvimento psicomotor, déficits cognitivos e algumas particularidades comportamentais. Tais dados parecem confirmar a idéia segundo a qual a esquizofrenia corresponderia a um distúrbio neurodesenvolvimental cuja expressão varia ao longo da vida. As especificidades clínicas e evolutivas dos raros casos de esquizofrenia iniciando-se na infância levam alguns autores a pensar que se trataria de uma entidade específica e cujo pertencimento ao “espectro autista” necessita ainda ser estudado.
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Mattejat F, Hirt BR, Wilken J, Schmidt MH, Remschmidt H. Efficacy of inpatient and home treatment in psychiatrically disturbed children and adolescents. Follow-up assessment of the results of a controlled treatment study. Eur Child Adolesc Psychiatry 2002; 10 Suppl 1:I71-9. [PMID: 11794558 DOI: 10.1007/s007870170008] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In two German child and adolescent psychiatric treatment and research centers, a controlled treatment study was conducted in which two randomized treatment groups (in-patient treatment and home treatment) were compared. Subjects were children and adolescents with severe psychiatric disorders, for whom normal outpatient treatment was not sufficient (mean age of the patients was 11 years and 9 months at the beginning of treatment). The results showed no differences in therapy outcome between the two treatment modalities. In a further study, the results of which are presented here, a follow-up assessment (average follow-up interval: 3 years and 8 months) of the two treatment groups (follow-up sample of the inpatient treatment group: n = 33; home treatment group: n = 35) was undertaken in order to investigate the course of the psychiatric disturbances and the long-term effects of the treatments. As measurement categories for the outcome "adaption at school" and "number of marked symptoms" were used in pre-, post- and follow-up assessment. The most important results are 1) The number of marked psychiatric symptoms and the adaptation at school or work exhibit the same type of course over time. Post-treatment scores are much better when compared to pre-treatment scores, but decline slightly upon follow-up, although they remain significantly better than the pre-treatment scores. Thus, the study shows that improvements relating to the psychiatric symptoms are quite stable after several years. 2) There were no relevant differences between the treatment modalities "inpatient treatment" and "home treatment" in terms of effect-size upon follow-up, and in inferential analysis. Any tendency towards difference was in favor of home treatment. So the results give strong support to the conclusion that at least for a specific group of patients (about 15% of those patients usually treated in an inpatient setting) residential treatment can be replaced by home treatment and that the long-term therapeutic outcome of home treatment is stable and persistent. Thus, in terms of psychiatric care and clinical practice, our results provide empirical support to the idea that home treatment should be used more frequently and much more broadly in the future.
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Affiliation(s)
- F Mattejat
- Dept. of Child and Adolescent Psychiatry, Philipps-University, Marburg, Germany.
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11
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Niederhofer H, Kucan S, Hackenberg B, Huber M, Gasteiger W. [Early childhood psychosis versus early childhood autism? Differential diagnosis based on one week observation in an inpatient setting]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2002. [PMID: 11876084 DOI: 10.1024//1422-4917.30.1.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report on the case of a 4-year old child suffering for the past six months from a lingering psychotic development. Several months of outpatient observation did not permit a clear differential diagnosis of either childhood autism or an early psychosis. During a one-week inpatient stay at our hospital recurring productive-psychotic episodes were observed that finally led to the exclusion of the diagnosis of "childhood autism" (ICD-10 F 84.0 (Dilling et al., 1993)) and to the diagnosis of "other disintegrative childhood disorder" (ICD-10: F 84.3 (Dilling et al., 1993)).
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Affiliation(s)
- H Niederhofer
- Univ.-Klinik für Psychiatrie, Abt. für Kinder- und Jugendpsychiatrie, Innsbruck
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12
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Hummel P, Guddack S. Psychosocial stress and adaptive functioning in children and adolescents suffering from hypohidrotic ectodermal dysplasia. Pediatr Dermatol 1997; 14:180-5. [PMID: 9192408 DOI: 10.1111/j.1525-1470.1997.tb00233.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In its fully manifest form, hypohidrotic ectodermal dysplasia (HED) leads to a typical dysmorphia of the face, referred to as "old man" facies. Few studies have been conducted on how children and adolescents deal with and adapt to the effects of this illness. The psychosocial stress and adaptive functioning of such patients was investigated by means of a semistructured interview conducted on a sample of 14 children and adolescents with varying degrees of this disease. The results revealed that adaptive functioning is not only dependent on the severity of symptoms. The child's intellectual potential and personality, how the disease is dealt with within the family, and reactions from the child's environment influence adaptive functioning in different ways.
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Affiliation(s)
- P Hummel
- Department of Child and Adolescent Psychiatry, University of Göttingen, Germany
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13
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Alaghband-Rad J, McKenna K, Gordon CT, Albus KE, Hamburger SD, Rumsey JM, Frazier JA, Lenane MC, Rapoport JL. Childhood-onset schizophrenia: the severity of premorbid course. J Am Acad Child Adolesc Psychiatry 1995; 34:1273-83. [PMID: 7592264 DOI: 10.1097/00004583-199510000-00012] [Citation(s) in RCA: 131] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To review the premorbid histories of 23 children meeting DSM-III-R criteria for schizophrenia with onset before age 12 years and to compare these with childhood data of later-onset schizophrenics. METHOD Premorbid features up to 1 year before onset of first psychotic symptoms were rated from hospital and clinic records, clinical interviews, rating scales, and tests. RESULTS In keeping with previous studies, specific developmental disabilities and transient early symptoms of autism, particularly motor stereotypies, were common. Comparison with the childhood of later-onset schizophrenics showed greater delay in language development, and more premorbid speech and language disorders, learning disorders, and disruptive behavior disorders. (Sixty percent had received or were estimated to meet criteria for one or more clinical diagnoses.) CONCLUSIONS Childhood-onset schizophrenia may represent a more malignant form of the disorder, although selection and ascertainment bias cannot be ruled out. The presence of prepsychotic language difficulties focuses attention on the importance of early temporal and frontal lobe development; early transient motor stereotypies suggest developmental basal ganglia abnormalities and extend previous findings seen in the childhood of later-onset patients.
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Affiliation(s)
- J Alaghband-Rad
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892, USA
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14
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Iida J, Iwasaka H, Hirao F, Hashino K, Matsumura K, Tahara K, Aoyama F, Sakiyama S, Tsujimoto H, Kawabata Y, Ikawa G. Clinical features of childhood-onset schizophrenia with obsessive-compulsive symptoms during the prodromal phase. Psychiatry Clin Neurosci 1995; 49:201-7. [PMID: 9179938 DOI: 10.1111/j.1440-1819.1995.tb01885.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Thirty-nine patients with schizophrenia, diagnosed according to DSM-III-R, who were under 15 years of age, were studied in two groups; 16 subjects with obsessive-compulsive symptoms during the prodromal phase, and 23 with no obsessive-compulsive disorders. The group with obsessive-compulsive symptoms during the prodromal phase was characterized by a higher ratio of males, higher incidences of perinatal and brain computed tomography (CT) abnormalities, fewer hereditary factors, longer duration of the prodromal phase, and a higher incidence of insidious onset and negative symptoms compared with the group without such prodromal symptoms. Schizophrenic patients with obsessive-compulsive symptoms during the prodromal phase were clinically distinct from those without, which suggests the possibility of subtype categorization.
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Affiliation(s)
- J Iida
- Department of Psychiatry, Nara Medical University, Japan
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15
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Abstract
A total of 232 (84%) first episodes of schizophrenia from our epidemiologically defined ABC sample (Age, Beginning and Course) were retrospectively assessed with regard to the onset and early course of the disorder. In a follow-up study a representative subgroup (n = 133) was prospectively examined in five cross sections over 3 years from first admission on. Population-based incidence rates for 5-year age groups comprising a range of < 10 - < 60 years were calculated on the basis of two definitions of onset: first sign of disorder and first psychotic symptom. In 40% of adult patients who had been admitted with a first schizophrenic episode after age 20 years the prodromal phase, in 11% the psychotic prephase, began before that age. This demonstrates that schizophrenia often begins in an age period in which the social and cognitive development and brain maturation are still unfinished. Early-onset schizophrenias (< or = 20 years) were compared with a medium-onset group (21 - < 35 years) and a late-onset group (35 - < 60 years) with regard to age and type of onset, early symptom-related course, social development and social course. The number of schizophrenia-specific positive and negative syndromes in early-onset schizophrenia is comparable to that of higher age groups. However, neurotic syndromes, emotional disorders and conduct disorders are most frequent in younger patients, especially in young men. Paranoid syndromes seem to prevail in late-onset schizophrenia, whereas less differentiated positive syndromes, such as delusional mood, are more frequent in the youngest age group. An earlier onset of schizophrenia has more severe social consequences than onset in adults, because it interrupts the cognitive and social development at an earlier stage. The worse social course of schizophrenia in men compared with women cannot be related to a more severe symptomatology, but to the earlier age at onset and the impairment or stagnation of social ascent at an earlier stage of social and cognitive development. Social disability in the sense of an adaptation to the expectations of the social environment, as well as symptomatology during the further course of schizophrenia, show no major differences between the genders nor between the age groups.
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16
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Blanz B, Schmidt MH, Detzner U, Lay B. Is there a sex-specific difference in onset age of schizophrenia that started before age 18? Eur Child Adolesc Psychiatry 1994; 3:267-276. [PMID: 29871461 DOI: 10.1007/bf01978115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Schizophrenia in male adults starts on average 4-5 years earlier than in females. The lifetime risk for both sexes is equal. It is still unknown, whether this observation is also valid for children and adolescents. This question was examined in the present study by means of data from the literature and a study of our own (n=118). From a total of 28 studies, only eight used standardized diagnostic criteria and confined the age range from 11 to 18 years. Neither the data of these eight studies nor those of the Mannheim-Study indicate an earlier onset of schizophrenia in male adolescents. Possible reasons are discussed.
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Affiliation(s)
- Bernd Blanz
- Department of Child and Adolescent Psychiatry, J 5, Central Institute of Mental Health, D-68159, Mannheim, Germany
| | - Martin H Schmidt
- Department of Child and Adolescent Psychiatry, J 5, Central Institute of Mental Health, D-68159, Mannheim, Germany
| | - Ulrike Detzner
- Department of Child and Adolescent Psychiatry, J 5, Central Institute of Mental Health, D-68159, Mannheim, Germany
| | - Barbara Lay
- Department of Child and Adolescent Psychiatry, J 5, Central Institute of Mental Health, D-68159, Mannheim, Germany
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17
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Abstract
58 psychotic adolescents between the ages of 12 and 17 diagnosed according to RDC criteria were matched with psychiatric comparisons and followed-up using a two stage design. Information upon the group as a whole was obtained using death records, criminal records and data from the Oxford Record Linkage System. A sub-sample of 21 matched pairs were interviewed using the Schedule for Affective Disorders and Schizophrenia--Life time version (SADS-L) and the Adult Personality Functioning Assessment (APFA). The outcome of adolescent schizophrenia was poor with 78% continuously ill and socially handicapped. Outcome was better for bipolar disorders and schizo-affective disorders and similar to psychiatric comparisons.
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Affiliation(s)
- P Cawthron
- Thorneywood Child and Adolescent Psychiatry Unit, Nottingham, U.K
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18
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McKenna K, Gordon CT, Rapoport JL. Childhood-onset schizophrenia: timely neurobiological research. J Am Acad Child Adolesc Psychiatry 1994; 33:771-81. [PMID: 7521867 DOI: 10.1097/00004583-199407000-00001] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To review timely research on childhood-onset schizophrenia in view of advances in biological research on, and neurodevelopmental theories of, the later-onset disorder. METHOD Research issues are outlined including further clarification of ICD- and DSM-defined childhood schizophrenia, and differentiation from autism "spectrum" and other subtle, chronic developmental disorders. Key neurobiological advances are reviewed for which child studies are relevant and feasible. CONCLUSION It is anticipated that narrowly defined childhood-onset schizophrenics will constitute a predominantly male population. A high rate of family illness or chromosomal and/or brain developmental abnormalities, which will be instructive regarding the pathophysiology of later-onset schizophrenia, is expected.
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Affiliation(s)
- K McKenna
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892
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19
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Frazier JA, Gordon CT, McKenna K, Lenane MC, Jih D, Rapoport JL. An open trial of clozapine in 11 adolescents with childhood-onset schizophrenia. J Am Acad Child Adolesc Psychiatry 1994; 33:658-63. [PMID: 8056728 DOI: 10.1097/00004583-199406000-00006] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To review the response of 11 adolescents with childhood-onset schizophrenia to a 6-week open clozapine trial. METHOD Eleven children meeting DSM-III-R criteria for schizophrenia had a 6-week open trial of clozapine (mean sixth week daily dose 370 mg). Behavioral ratings included the Brief Psychiatric Rating Scale and Children's Global Assessment Scale. RESULTS More than half showed marked improvement in Brief Psychiatric Rating Scale ratings by 6 weeks of clozapine therapy compared to admission drug rating and compared to a systematic 6-week trial of haloperidol. CONCLUSIONS This open trial indicates that clozapine may be a promising treatment for children and adolescents with schizophrenia who do not respond well to typical neuroleptics. A double-blind placebo-controlled study is ongoing.
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Affiliation(s)
- J A Frazier
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892
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20
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Sverd J, Montero G, Gurevich N. Brief report: cases for an association between Tourette syndrome, autistic disorder, and schizophrenia-like disorder. J Autism Dev Disord 1993; 23:407-13. [PMID: 8331056 DOI: 10.1007/bf01046229] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- J Sverd
- Sagamore Children's Psychiatric Center, Dix Hills, New York 11746
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21
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McClellan JM, Werry JS, Ham M. A follow-up study of early onset psychosis: comparison between outcome diagnoses of schizophrenia, mood disorders, and personality disorders. J Autism Dev Disord 1993; 23:243-62. [PMID: 8331046 DOI: 10.1007/bf01046218] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study examined the outcome of youth previously diagnosed with psychotic disorders at a public-sector tertiary care hospital. Of 95 children and adolescents retrospectively identified, follow-up information (mean interval 3.9 years) was obtained on 24 subjects with an outcome diagnosis of schizophrenia, 9 with psychotic mood disorders, 5 with personality disorders (antisocial or borderline), and 1 with schizo-affective disorder. The schizophrenic group was more often odd premorbidly and functioned worse at outcome, while the mood-disordered group had a shorter follow-up period and was more often anxious or dysthymic premorbidly. The personality-disordered group resembled the schizophrenics in their degree of impairment and chronicity. All three groups had high rates of family disruption, low SES, substance abuse, and chronicity, and were similar in their degree of premorbid impairment, length of prodrome, age of onset, initial diagnosis, and family psychiatric history. Misdiagnosis at onset was quite common and highlights the need for systematic longitudinal assessment of early onset psychotic disorders.
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Affiliation(s)
- J M McClellan
- Department of Psychiatry, University of Washington, Seattle 98109
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22
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Werry JS. Child and adolescent (early onset) schizophrenia: a review in light of DSM-III-R. J Autism Dev Disord 1992; 22:601-24. [PMID: 1483979 DOI: 10.1007/bf01046330] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Early onset schizophrenia (EOS) is defined as that beginning in childhood or adolescence (under 16 or 17). Studies of EOS are infrequent, and comparative adult figures not always available, but tentative conclusions may be drawn. EOS is more common in males; symptomatology is often undifferentiated; frequencies of homotypic family disorder, premorbid schizotypal personality, and neurodevelopmental abnormalities high; outcome poor but only slightly worse than in adults; response to psychotropic drug treatment probably similar though not properly tested; and confusion with psychotic bipolar disorder particularly common. Onset before language is developed presents special diagnostic difficulties. There are a few reports of autistic children developing schizophrenia but this requires replication. Differences from adult schizophrenia are more marked when onset is in childhood than in adolescence but all are quantitative rather than qualitative suggesting that the disorders are the same and that there should be no separate category for children or adolescents.
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Affiliation(s)
- J S Werry
- School of Medicine, University of Auckland, New Zealand
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23
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Green WH, Padron-Gayol M, Hardesty AS, Bassiri M. Schizophrenia with childhood onset: a phenomenological study of 38 cases. J Am Acad Child Adolesc Psychiatry 1992; 31:968-76. [PMID: 1400132 DOI: 10.1097/00004583-199209000-00027] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Thirty-eight hospitalized children, ages 5.7 to 11.11 years, diagnosed with schizophrenic disorder by DSM-III criteria, are characterized regarding age, sex, race, socioeconomic status, pre- and perinatal complications, electroencephalogram, intelligence quotient, and family history of major psychiatric disorder. Clinical course, including age at onset of general and psychotic psychiatric symptoms and initial diagnosis of schizophrenic disorder, presence of DSM-III symptoms, hospital course, and response to antipsychotics are reviewed.
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Affiliation(s)
- W H Green
- Department of Psychiatry, New York University-Bellevue Medical Center
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24
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Affiliation(s)
- W L Parry-Jones
- University of Glasgow, Department of Child and Adolescent Psychiatry, Royal Hospital for Sick Children, Yorkhill
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25
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Werry JS, McClellan JM, Chard L. Childhood and adolescent schizophrenic, bipolar, and schizoaffective disorders: a clinical and outcome study. J Am Acad Child Adolesc Psychiatry 1991; 30:457-65. [PMID: 2055884 DOI: 10.1097/00004583-199105000-00017] [Citation(s) in RCA: 247] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Fifty-nine child and adolescent psychotic patients (mean onset age 13.9, range 7-17, 83% 13 + years) had history and outcome studied using diagnoses confirmed at follow-up after 1 to 16 years (mean, 5 years). There were no differences in sex ratio, socioeconomic status, age of onset, and symptoms, but bipolar patients (N = 23) were often misdiagnosed as schizophrenic, had a better outcome, and a 50% homotypic family history. Schizophrenic subjects (N = 30) were more abnormal premorbidly, and only 17% were well at follow-up. Schizoaffective disorder was unreliable, infrequent, and more severe. Premorbid adjustment and IQ were the best predictors of outcome. Differences from the adult disorders were only quantitative. Careful follow-up of psychotic patients is needed to detect diagnostic errors.
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Affiliation(s)
- J S Werry
- School of Medicine, University of Auckland, New Zealand
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26
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Tompson M, Asarnow J, Goldstein M, Miklowitz D. Thought Disorder and Communication Problems in Children With Schizophrenia Spectrum and Depressive Disorders and Their Parents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 1990. [DOI: 10.1207/s15374424jccp1902_8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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27
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Abstract
Symptom development from birth to 12 years of age was examined in 18 children who met DSM-III criteria for schizophrenia with onset before 10 years of age. Using a follow-back design, symptom development was rated at each of four age levels using a DSM-III Symptom Rating Scale and the Achenbach Child Behavior Checklist. Results revealed a gradual developmental unfolding of a broad spectrum of symptoms affecting social, cognitive, sensory and motor functioning and beginning many years before the appearance of schizophrenic symptoms--usually in early infancy. Prior to 6 years of age, severe language deficits and motor development problems were each found in 72% of the sample and symptoms of infantile autism were found in 39% of the sample. Onset of schizophrenia occurred at an earlier age for children with a history of autistic symptoms during infancy than for other children in the sample. Schizophrenia as defined by DSM-III was entirely absent before 6 years of age.
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Affiliation(s)
- J M Watkins
- Department of Psychology, University of California, Los Angeles
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28
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Asarnow JR, Ben-Meir S. Children with schizophrenia spectrum and depressive disorders: a comparative study of premorbid adjustment, onset pattern and severity of impairment. J Child Psychol Psychiatry 1988; 29:477-88. [PMID: 3215919 DOI: 10.1111/j.1469-7610.1988.tb00738.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Premorbid adjustment, onset patterns, and severity of impairment were examined in 66 child psychiatric inpatients with diagnoses of schizophrenia, schizotypal personality disorder, major depression, and dysthymic disorder. When compared to children with depressive disorders, schizophrenic and schizotypal children showed poorer premorbid adjustments, lower IQs, greater impairment at hospitalization, and more chronic dysfunctions. Similar developmental patterns were found for children with schizophrenic and schizotypal disorders, and for children with major depression and dysthymic disorders. The findings underscore the severe impairment in social adaptation shown by schizophrenic and schizotypal children and the relatively good premorbid adjustments of most depressed children.
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29
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Campbell M, Spencer EK. Psychopharmacology in child and adolescent psychiatry: a review of the past five years. J Am Acad Child Adolesc Psychiatry 1988; 27:269-79. [PMID: 3288611 DOI: 10.1097/00004583-198805000-00001] [Citation(s) in RCA: 67] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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30
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Abstract
Age of onset of psychiatric disorders was determined from a random sample of 3,258 household residents who were administered the DIS by trained lay interviewers. Onset was determined by the subject's recall of the age of the first symptom in those who met lifetime criteria for a diagnosis (DSM III without exclusions). The peak age of risk for most disorders was from the teens to 30 years, however a number of schizophrenics showed first symptoms before age 10. Few cases of any disorder had an onset in old age. The ages of onset are generally lower than those usually given from series of treated or hospitalized cases.
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Affiliation(s)
- R C Bland
- Department of Psychiatry, University of Alberta, Edmonton, Canada
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31
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Rutter M, Schopler E. Autism and pervasive developmental disorders: concepts and diagnostic issues. J Autism Dev Disord 1987; 17:159-86. [PMID: 3610994 DOI: 10.1007/bf01495054] [Citation(s) in RCA: 245] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The purpose of this report is to bring up to date available information on the defining features and diagnostic issues relating to autism and related disorders. We review the validity of the syndrome based on our last review (Rutter, 1978; Schopler, 1978). Subsequent data have produced refinement in our understanding of both diagnostic criteria and the nature of the basic deficit. Controversies over both the boundaries and the heterogeneity within the autism syndrome are evaluated according to available evidence. Diagnostic rating instruments for expediting systematic sample selection are critiqued, and leads for new research directions are suggested.
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32
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Tanguay PE, Cantor SL. Schizophrenia in children. Introduction. JOURNAL OF THE AMERICAN ACADEMY OF CHILD PSYCHIATRY 1986; 25:591-4. [PMID: 3760407 DOI: 10.1016/s0002-7138(09)60282-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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33
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Inoue K, Nakajima T, Kato N. A longitudinal study of schizophrenia in adolescence. I. The one- to three-year outcome. THE JAPANESE JOURNAL OF PSYCHIATRY AND NEUROLOGY 1986; 40:143-51. [PMID: 3784157 DOI: 10.1111/j.1440-1819.1986.tb03136.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In an attempt to evaluate retrospectively the three-year course and outcome of treated adolescent schizophrenics, the medical data of 19 patients were collected from the first admissions over a period of 10 years (1971-1981). According to the DSM-III criteria, 17 were diagnosed as having schizophrenic disorders and the remaining 2 were schizophreniform disorders. The outcome at the time of first- to third-year follow-up was assessed on the outcome rating scale. The three-year outcome was favorable with respect to both the length of hospitalization and the presence of psychotic symptoms. However, there was a sustained impairment in occupational (or scholastic) functioning throughout the three-year follow-up period. The female sex and the initial diagnosis of schizophreniform disorder might be factors affecting the good third-year clinical (or symptomatic) outcome. The younger age at onset, the longer duration of the prodromal phase, and the longer period of time between the onset and the first presentation appeared to predict the poor third-year occupational outcome.
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34
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Gillberg C, Wahlström J, Forsman A, Hellgren L, Gillberg IC. Teenage psychoses--epidemiology, classification and reduced optimality in the pre-, peri- and neonatal periods. J Child Psychol Psychiatry 1986; 27:87-98. [PMID: 3949910 DOI: 10.1111/j.1469-7610.1986.tb00624.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This is a population-based survey from Göteborg, Sweden, of all youngsters treated as in-patients for operationally defined 'psychotic disorders' during their teens. It was shown that 0.54% of all teenagers in Göteborg had been treated for such disorders at least once during the 13- to 19-year-old age period. Boys and girls were about equally affected, but schizophreniform disorders tended to be much more common among the boys and affective disorders more common among the girls. Child psychiatric services had been consulted much less frequently than adult ones, in spite of the many developmental aspects of the psychotic disorders. Scores for reduced optimality in the pre- and perinatal periods were marginally, though significantly, more common in the psychosis groups than in an age-, sex- and maternity clinic-matched control group.
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