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Di Luzio M, Pontillo M, Villa M, Attardi AG, Bellantoni D, Di Vincenzo C, Vicari S. Clinical features and comorbidity in very early-onset schizophrenia: a systematic review. Front Psychiatry 2023; 14:1270799. [PMID: 38152354 PMCID: PMC10752227 DOI: 10.3389/fpsyt.2023.1270799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/16/2023] [Indexed: 12/29/2023] Open
Abstract
Background Very early-onset schizophrenia (VEOS) is a form of schizophrenia that manifests before the age of 13 years and is characterized by the presence of positive, negative, and disorganized symptoms. The condition is exceptionally rare and, to date, limited studies have been conducted, resulting in incomplete information about its clinical features. Methods The present study involves a systematic review of the existing literature regarding the clinical features and comorbidities of VEOS. Results The first search retrieved 384 studies. Of these, 366 were removed following the application of exclusion criteria, resulting in 18 studies for the final set. Conclusion The results highlight that VEOS shares similarities with early-onset and adult-onset schizophrenia but also exhibits distinct and recognizable characteristics, including a more severe clinical profile (particularly in females), increased visual hallucinations, and high comorbidities with neurodevelopmental disorders. These findings may support clinicians in formulating early diagnoses and developing effective treatment strategies for pediatric and adolescent patients with psychosis.
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Affiliation(s)
- Michelangelo Di Luzio
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Pontillo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marianna Villa
- Life Sciences and Public Health Department, Catholic University, Rome, Italy
| | - Anna Gaia Attardi
- Department of Human Pathology of the Adult and Developmental Age "Gaetano Barresi", Unit of Child Neurology and Psychiatry, University of Messina, Messina, Italy
- School of Child Neurology and Psychiatry, PROMISE Department, University of Palermo, Palermo, Italy
| | - Domenica Bellantoni
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cristina Di Vincenzo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Life Sciences and Public Health Department, Catholic University, Rome, Italy
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Zhong Y, Tubbs JD, Leung PBM, Zhan N, Hui TCK, Ho KKY, Hung KSY, Cheung EFC, So HC, Lui SSY, Sham PC. Early-onset schizophrenia is associated with immune-related rare variants in a Chinese sample. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.21.23298115. [PMID: 38045317 PMCID: PMC10690336 DOI: 10.1101/2023.11.21.23298115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Rare variants are likely to contribute to schizophrenia (SCZ), given the large discrepancy between the heritability estimated from twin and GWAS studies. Furthermore, the nature of the rare-variant contribution to SCZ may vary with the "age-at-onset" (AAO), since early-onset has been suggested as being indicative of neurodevelopment deviance. Objective To examine the association of rare deleterious coding variants in early- and adult-onset SCZ in a Chinese sample. Method Exome sequencing was performed on DNA from 197 patients with SCZ spectrum disorder and 82 healthy controls (HC) of Chinese ancestry recruited in Hong Kong. We also gathered AAO information in the majority of SCZ samples. Patients were classified into early-onset (EOS, AAO<18) and adult-onset (AOS, AAO>18). We collapsed the rare variants to improve statistical power and examined the overall association of rare variants in SCZ versus HC, EOS versus HC, and AOS versus HC at the gene and gene-set levels by Sequence Kernel Association Test. The quantitative rare-variant association test of AAO was also conducted. We focused on variants which were predicted to have a medium or high impact on the protein-encoding process as defined by Ensembl. We applied a 100000-time permutation test to obtain empirical p-values, with significance threshold set at p < 1e -3 to control family-wise error rates. Moreover, we compared the burden of targeted rare variants in significant risk genes and gene sets in cases and controls. Results Based on several binary-trait association tests (i.e., SCZ vs HC, EOS vs HC and AOS vs HC), we identified 7 candidate risk genes and 20 gene ontology biological processes (GOBP) terms, which exhibited higher burdens in SCZ than in controls. Based on quantitative rare-variant association tests, we found that alterations in 5 candidate risk genes and 7 GOBP pathways were significantly correlated with AAO. Based on biological and functional profiles of the candidate risk genes and gene sets, our findings suggested that, in addition to the involvement of perturbations in neural systems in SCZ in general, altered immune responses may be specifically implicated in EOS. Conclusion Disrupted immune responses may exacerbate abnormal perturbations during neurodevelopment and trigger the early onset of SCZ. We provided evidence of rare variants increasing SCZ risk in the Chinese population.
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Huang H, Luo J, Qi Y, Wu Y, Qi J, Yan X, Xu G, He F, Zheng Y. Comprehensive analysis of circRNA expression profile and circRNA-miRNA-mRNA network susceptibility to very early-onset schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:70. [PMID: 37816766 PMCID: PMC10564922 DOI: 10.1038/s41537-023-00399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/22/2023] [Indexed: 10/12/2023]
Abstract
To explore the potential role of circular RNAs (circRNAs) in children developing very early-onset schizophrenia (VEOS). Total RNA was extracted from the plasma samples of 10 VEOS patients and eight healthy controls. Expression profiles of circRNAs, micro RNAs (miRNAs), and messenger RNAs (mRNAs) were analyzed using RNA-seq. The interaction networks between miRNAs and targets were predicted using the miRanda tool. A differentially expressed circRNA-miRNA-mRNA (ceRNA) network was further constructed. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses of the target mRNAs in the ceRNA network were performed to predict the potential functions of their host genes. The patient group and the control group were also compared on the regulatory patterns of circRNAs on mRNAs. 1934 circRNAs were identified from the samples and reported for the first time in schizophrenia. The circRNA expression levels were lower in the VEOS group than in the healthy control group, and 1889 circRNAs were expressed only in the control group. Differential expression analysis (i.e., log2fold change > 1.5, p 0.05) identified 235 circRNAs (1 up-regulated, 234 down-regulated), 11 miRNAs (7 up-regulated, 4 down-regulated), and 2,308 mRNAs (1906 up-regulated, 402 down-regulated) respectively. In VEOS, a ceRNA network with 10 down-regulated circRNA targets, 6 up-regulated miRNAs, and 47 down-regulated mRNAs was constructed. The target genes were involved in the membrane, the signal transduction, and the cytoskeleton and transport pathways. Finally, different expression correlation patterns of circRNA and mRNA in the network were observed between the patient group and the control group. The current research is the first to reveal the differentially expressed circRNAs in the plasma of VEOS patients. A circRNA-miRNA-mRNA network was also conducted in this study. It may be implied that the circRNAs in this network are potential diagnostic biomarkers for VEOS and they play an important role in the onset and development of VEOS symptoms.
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Affiliation(s)
- Huanhuan Huang
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, Beijing, People's Republic of China
| | - Jie Luo
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, Beijing, People's Republic of China
| | - Yanjie Qi
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, Beijing, People's Republic of China
| | - Yuanzhen Wu
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, Beijing, People's Republic of China
| | - Junhui Qi
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, Beijing, People's Republic of China
| | - Xiuping Yan
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, Beijing, People's Republic of China
| | - Gaoyang Xu
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, Beijing, People's Republic of China
| | - Fan He
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, Beijing, People's Republic of China.
| | - Yi Zheng
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Beijing Institute for Brain Disorders Capital Medical University, Beijing, People's Republic of China.
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Di Luzio M, Guerrera S, Pontillo M, Lala MR, Casula L, Valeri G, Vicari S. Autism spectrum disorder, very-early onset schizophrenia, and child disintegrative disorder: the challenge of diagnosis. A case-report study. Front Psychiatry 2023; 14:1212687. [PMID: 37575588 PMCID: PMC10416439 DOI: 10.3389/fpsyt.2023.1212687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background Autism spectrum disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) contains several disorders previously present as distinct diagnoses in the DSM Revised Fourth Edition (DSM-IV-TR). These include child disintegrative disorder (CDD). The latter presents typical features, such as a late regression of developmental acquisitions. However, it also shows symptoms similar to ASD, and psychotic symptoms, such as very-early onset schizophrenia (VEOS), are described in the literature. Case report In this case report we deepen the case of P., a child who presents a late regression, at 7 years old, associated with psychotic symptoms in the absence of organic alterations. The child was treated with antipsychotic drug therapy and cognitive behavioral therapy. P. was diagnosed with ASD with acute and late regression associated with psychotic symptoms. During the follow-up, there was a gradual improvement in the clinical conditions. Improvements were possible due to therapeutic intervention (pharmacological and psychotherapeutic) and/or the natural course of the disorder. Conclusion The diagnostic difficulty of this case reflects a clinical complexity in which it is not easy to distinguish between neurodevelopmental and psychiatric aspects. Clinical cases such as that of P. emphasize the theme of the neurodevelopment continuum model in which neurodevelopmental and psychiatric disturbances can be considered within a pattern of pathological continuity.
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Affiliation(s)
- Michelangelo Di Luzio
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Silvia Guerrera
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Maria Pontillo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Maria Rosaria Lala
- Life Sciences and Public Health Department, Catholic University, Rome, Italy
| | - Laura Casula
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giovanni Valeri
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Life Sciences and Public Health Department, Catholic University, Rome, Italy
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Cuñat O, Del Hoyo-Buxo B, Vila-Badia R, Serra-Arumí C, Butjosa A, Del Cacho N, Colomer-Salvans A, Dolz M, Cuevas-Esteban J, Iglesias-González M, Usall J, Profep Group. Negative symptoms in drug-naive patients with a first-episode psychosis (FEP). Asian J Psychiatr 2023; 81:103448. [PMID: 36652842 DOI: 10.1016/j.ajp.2023.103448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/02/2023] [Accepted: 01/02/2023] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Negative symptoms are nuclear features of schizophrenia that may be present from the onset of the disease. In recent years, it has been described 2 subdomains of negative symptoms: experiential and expressive deficits. The aim of the study is to examine the relationship between negative symptoms and demographic and clinical variables in patients with first-episode psychosis. Also, to explore whether there are differences in the association among these variables and negative symptoms when divided into both subdomains. MATERIAL AND METHODS A cross-sectional study was performed in 160 patients (52 females and 108 males) with a diagnosis of a first episode psychosis. A questionnaire was administered to collect demographic and clinical variables. RESULTS A backward stepwise linear regressions analysis was performed in order to observe potential associations between demographic and clinical variables and the presence of negative symptoms. All three models are predicted by worse PSP score, a higher CDSS, a higher disorganized factor score and a lower excited factor score. A longer duration of untreated psychosis (DUP) is associated to a higher score in the experiential deficit subdomain only. CONCLUSIONS Our work highlights some clinical and phenomenological differences between experiential and expressive deficits. We think that taking into account both subdomains in future studies may lead to more accurate clinical assessment and interventions.
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Affiliation(s)
- O Cuñat
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain.
| | - B Del Hoyo-Buxo
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
| | - R Vila-Badia
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - C Serra-Arumí
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - A Butjosa
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Hospital Infanto-juvenil Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, CIBERSAM, Esplugues de Llobregat, Spain
| | - N Del Cacho
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - A Colomer-Salvans
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - M Dolz
- Hospital Infanto-juvenil Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, CIBERSAM, Esplugues de Llobregat, Spain
| | - J Cuevas-Esteban
- Hospital Universitari Germans Trias i Pujol, CIBERSAM, Badalona, Spain; Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - M Iglesias-González
- Hospital Universitari Germans Trias i Pujol, CIBERSAM, Badalona, Spain; Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - J Usall
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Profep Group
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain; Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
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Guo P, Hu S, Jiang X, Zheng H, Mo D, Cao X, Zhu J, Zhong H. Associations of Neurocognition and Social Cognition With Brain Structure and Function in Early-Onset Schizophrenia. Front Psychiatry 2022; 13:798105. [PMID: 35222115 PMCID: PMC8866448 DOI: 10.3389/fpsyt.2022.798105] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cognitive impairment is a core feature of schizophrenia that is more serious in patients with early-onset schizophrenia (EOS). However, the neuroimaging basis of cognitive functions, including neurocognition and social cognition, remains unclear in patients with EOS. METHODS Forty-three patients with EOS underwent structural and resting state functional magnetic resonance imaging scans. Brain structure and function were evaluated through the analysis of brain gray matter volume (GMV) and amplitude of low-frequency fluctuations (ALFF). They underwent comprehensive assessments for neurocognition (verbal memory, verbal expression, attention, and executive function) and social cognition (theory of mind and attributional bias). Correlation analyses were conducted to detect the potential link between cognitive function indices and brain imaging parameters. RESULTS First, neurocognition was linked to brain structure characterized by higher immediate recall scores associated with increased GMV in the left temporal pole, higher verbal fluency scores associated with increased GMV in the left temporal pole: middle temporal gyrus, and higher Stroop-word scores associated with increased GMV in the right middle frontal gyrus. Second, social cognition was related to brain function characterized by lower sense of reality scores associated with increased ALFF in the left precentral gyrus, higher scores of accidental hostility bias associated with increased ALFF in the right middle temporal gyrus, and higher scores of accidental aggression bias associated with increased ALFF in the left precentral gyrus. CONCLUSION These findings may add to the existing knowledge about the cognitive function-brain relationship. They may have clinical significance for studying the mechanism of neurocognitive and social cognitive impairment in patients with EOS and providing potential neural targets for their treatment and intervention.
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Affiliation(s)
- Pengfei Guo
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Shuwen Hu
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Xiaolu Jiang
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Hongyu Zheng
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Daming Mo
- Department of Child and Adolescent Mental Disorder, Anhui Mental Health Center, Hefei, China
| | - Xiaomei Cao
- Department of Child and Adolescent Mental Disorder, Anhui Mental Health Center, Hefei, China
| | - Jiajia Zhu
- Department of Radiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hui Zhong
- Department of Child and Adolescent Mental Disorder, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Department of Child and Adolescent Mental Disorder, Anhui Mental Health Center, Hefei, China
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Vita A, Barlati S, Bellomo A, Poli PF, Masi G, Nobili L, Serafini G, Zuddas A, Vicari S. Patterns of Care for Adolescent With Schizophrenia: A Delphi-Based Consensus Study. Front Psychiatry 2022; 13:844098. [PMID: 35432022 PMCID: PMC9007083 DOI: 10.3389/fpsyt.2022.844098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The current conceptualization of schizophrenia as neurodevelopmental disorder should lead to innovative public health policies in terms of a reorganization of the mental health care systems, particularly in the transition from adolescence to adulthood, to reduce personal, familiar, and social costs and burdens. The purpose of the project was to perform a survey among a panel of Italian schizophrenia experts, to share evidence-based information on adolescent schizophrenia and explore the degree of consensus among professionals in the following four macro-areas: early diagnosis; pharmacological treatment; health care system organization and transition process from adolescent to adulthood; and psychosocial interventions. METHODS The consensus process consisted of a two-step web-based Delphi method, which took place between June and November 2021. The survey was developed by a panel of four psychiatrists and four child neuropsychiatrists, identified as key opinion leaders (KOLs). The KOLs identified 21 statements involving a total of 70 items with a major need of clarification on early-onset schizophrenia (EOS). The survey was distributed to 86 specialists in psychiatry and child neuropsychiatry. RESULTS The results revealed a large agreement among the expert group on all the investigated areas of adolescent schizophrenia patterns of care and management. Consensus was ultimately reached for 67 items of the Delphi survey (95.7%), while negative consensus was reached for 2 items and no consensus was reached for 1 item. CONCLUSIONS Overall, results showed a significant gap between the acquired scientific knowledge and clinical practice. In this scenario, it should be necessary to plan specific initiatives at a multiple level, to edit recommendations on clinical decision-making, as well as to prompt changes at the political and organizational levels, also involving scientific societies, patients, and family associations, to overcome the barriers that delay the implementation process.
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Affiliation(s)
- Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Paolo Fusar Poli
- Department of Nervous System and Behavior Sciences, University of Pavia, Pavia, Italy
| | - Gabriele Masi
- Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Lino Nobili
- Child Neuropsychiatry, Genoa and Department of Neuroscience (DINOGMI), IRCCS G. Gaslini Institute, University of Genoa, Genoa, Italy
| | | | - Alessandro Zuddas
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefano Vicari
- Department of Life Sciences and Publich Health, Catholic University and Bambino Gesù, Rome, Italy.,Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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Abstract
BACKGROUND Psychosis is an illness characterised by alterations in thoughts and perceptions resulting in delusions and hallucinations. Psychosis is rare in adolescents but can have serious consequences. Antipsychotic medications are the mainstay treatment, and have been shown to be effective. However, there is emerging evidence on psychological interventions such as cognitive remediation therapy, psycho-education, family therapy and group psychotherapy that may be useful for adolescents with psychosis. OBJECTIVES To assess the effects of various psychological interventions for adolescents with psychosis. SEARCH METHODS We searched the Cochrane Schizophrenia Group's study-based Register of Trials including clinical trials registries (latest, 8 March 2019). SELECTION CRITERIA All randomised controlled trials comparing various psychological interventions with treatment-as-usual or other psychological treatments for adolescents with psychosis. For analyses, we included trials meeting our inclusion criteria and reporting useable data. DATA COLLECTION AND ANALYSIS We independently and reliably screened studies and we assessed risk of bias of the included studies. For dichotomous data, we calculated risk ratios (RRs) and 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous data, we used mean differences (MDs) and the 95% CIs. We used a random-effects model for analyses. We created a 'Summary of findings' table using GRADE. MAIN RESULTS The current review includes 7 studies (n = 319) assessing a heterogenous group of psychological interventions with variable risk of bias. Adverse events were not reported by any of the studies. None of the studies was sponsored by industry. Below, we summarise the main results from four of six comparisons, and the certainty of these results (based on GRADE). All scale scores are average endpoint scores. Cognitive Remediation Therapy (CRT) + Treatment-as-Usual (TAU) versus TAU Two studies compared adding CRT to participants' TAU with TAU alone. Global state (CGAS, high = good) was reported by one study. There was no clear difference between treatment groups (MD -4.90, 95% CI -11.05 to 1.25; participants = 50; studies = 1, very low-certainty). Mental state (PANSS, high = poor) was reported by one study. Scores were clearly lower in the TAU group (MD 8.30, 95% CI 0.46 to 16.14; participants = 50; studies = 1; very low-certainty). Clearly more participants in the CRT group showed improvement in cognitive functioning (Memory digit span test) compared to numbers showing improvement in the TAU group (1 study, n = 31, RR 0.58, 95% CI 0.37 to 0.89; very low-certainty). For global functioning (VABS, high = good), our analysis of reported scores showed no clear difference between treatment groups (MD 5.90, 95% CI -3.03 to 14.83; participants = 50; studies = 1; very low-certainty). The number of participants leaving the study early from each group was similar (RR 0.93, 95% CI 0.32 to 2.71; participants = 91; studies = 2; low-certainty). Group Psychosocial Therapy (GPT) + TAU versus TAU One study assessed the effects of adding GPT to participants' usual medication. Global state scores (CGAS, high = good) were clearly higher in the GPT group (MD 5.10, 95% CI 1.35 to 8.85; participants = 56; studies = 1; very low-certainty) but there was little or no clear difference between groups for mental state scores (PANSS, high = poor, MD -4.10, 95% CI -8.28 to 0.08; participants = 56; studies = 1, very low-certainty) and no clear difference between groups for numbers of participants leaving the study early (RR 0.43, 95% CI 0.15 to 1.28; participants = 56; studies = 1; very low-certainty). Cognitive Remediation Programme (CRP) + Psychoeducational Treatment Programme (PTP) versus PTP One study assessed the effects of combining two types psychological interventions (CRP + PTP) with PTP alone. Global state scores (GAS, high = good) were not clearly different (MD 1.60, 95% CI -6.48 to 9.68; participants = 25; studies = 1; very low-certainty), as were mental state scores (BPRS total, high = poor, MD -5.40, 95% CI -16.42 to 5.62; participants = 24; studies = 1; very low-certainty), and cognitive functioning scores (SPAN-12, high = good, MD 2.40, 95% CI -2.67 to 7.47; participants = 25; studies = 1; very low-certainty). Psychoeducational (PE) + Multifamily Treatment (MFT) Versus Nonstructured Group Therapy (NSGT, all long-term) One study compared (PE + MFT) with NSGT. Analysis of reported global state scores (CGAS, high = good, MD 3.38, 95% CI -4.87 to 11.63; participants = 49; studies = 1; very low-certainty) and mental state scores (PANSS total, high = poor, MD -8.23, 95% CI -17.51 to 1.05; participants = 49; studies = 1; very low-certainty) showed no clear differences. The number of participants needing hospital admission (RR 0.84, 95% CI 0.36 to 1.96; participants = 49; studies = 1) and the number of participants leaving the study early from each group were also similar (RR 0.52, 95% CI 0.10 to 2.60; participants = 55; studies = 1; low-certainty). AUTHORS' CONCLUSIONS Most of our estimates of effect for our main outcomes are equivocal. An effect is suggested for only four outcomes in the SOF tables presented. Compared to TAU, CRT may have a positive effect on cognitive functioning, however the same study reports data suggesting TAU may have positive effect on mental state. Another study comparing GPT with TAU reports data suggesting GPT may have a positive effect on global state. However, the estimate of effects for all the main outcomes in our review should be viewed with considerable caution as they are based on data from a small number of studies with variable risk of bias. Further data could change these results and larger and better quality studies are needed before any firm conclusions regarding the effects of psychological interventions for adolescents with psychosis can be made.
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Affiliation(s)
- Soumitra S Datta
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, India
| | - Rhea Daruvala
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, India
| | - Ajit Kumar
- Latrobe Regional Hospital, Victoria, Australia
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Auditory sensory gating in young adolescents with early-onset psychosis: a comparison with attention deficit/hyperactivity disorder. Neuropsychopharmacology 2020; 45:649-655. [PMID: 31649298 PMCID: PMC7021818 DOI: 10.1038/s41386-019-0555-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/23/2019] [Accepted: 10/17/2019] [Indexed: 01/08/2023]
Abstract
Numerous studies have demonstrated impaired sensory gating in schizophrenia and this impairment has been proposed as a candidate biomarker for the disorder. The typical age of onset for schizophrenia is early adulthood, however a sizable group of patients present with psychotic symptoms before the age of 18, commonly referred to as early-onset psychosis (EOP). How an earlier onset influences sensory gating is currently unknown. Impaired sensory gating may not be specific to psychosis, but rather a shared disturbance of neurodevelopmental disorders, such as attention deficit/hyperactivity disorder (ADHD). Therefore, the current study investigated P50 suppression in young adolescents (12-17 years old) with either EOP (N = 55) or ADHD (N = 28) and age and gender matched healthy controls (HC) (N = 71). In addition to P50 suppression, N100 and P200 suppression data were also analyzed. No significant group differences in either raw mean P50 amplitude or mean P50 gating ratios were observed between EOP, ADHD, and HC. Additionally, we observed no P50 suppression deficit in those EOP patients diagnosed with schizophrenia (N = 39). Similarly, we observed no differences in N100 or P200 between the three groups. Healthy levels of P50 suppression were found in both patient groups. The results are in line with some previous studies showing healthy levels of P50 suppression in the early phases of schizophrenia. Our findings do not support P50 sensory gating as a valid biomarker for EOP or ADHD.
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10
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Coulon N, Godin O, Bulzacka E, Dubertret C, Mallet J, Fond G, Brunel L, Andrianarisoa M, Anderson G, Chereau I, Denizot H, Rey R, Dorey JM, Lançon C, Faget C, Roux P, Passerieux C, Dubreucq J, Leignier S, Capdevielle D, André M, Aouizerate B, Misdrahi D, Berna F, Vidailhet P, Leboyer M, Schürhoff F. Early and very early-onset schizophrenia compared with adult-onset schizophrenia: French FACE-SZ database. Brain Behav 2020; 10:e01495. [PMID: 31908151 PMCID: PMC7010576 DOI: 10.1002/brb3.1495] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To compare the clinical symptomatology in patients with Early-Onset Schizophrenia (EOS, N = 176), especially the subgroup Very Early Onset Schizophrenia (VEOS) and Adult Onset Schizophrenia (AOS, N = 551). METHOD In a large French multicentric sample, 727 stable schizophrenia patients, classified by age at onset of the disorder, were assessed using standardized and extensive clinical and neuropsychological batteries: AOS with onset ≥ 18 years and EOS with onset < 18 years (including 22 VEOS < 13 years). RESULTS The importance of better diagnosing EOS group, and in particularly VEOS, appeared in a longer DUP Duration of Untreated Psychosis (respectively, 2.6 years ± 4.1 and 8.1 years ± 5.7 vs. 1.0 years ± 2.5), more severe symptomatology (PANSS Positive And Negative Syndrome Scale scores), and lower educational level than the AOS group. In addition, the VEOS subgroup had a more frequent childhood history of learning disabilities and lower prevalence of right-handedness quotient than the AOS. CONCLUSION The study demonstrates the existence of an increased gradient of clinical severity from AOS to VEOS. In order to improve the prognosis of the early forms of schizophrenia and to reduce the DUP, clinicians need to pay attention to the prodromal manifestations of the disease.
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Affiliation(s)
- Nathalie Coulon
- Fondation FondaMental, Créteil, France.,INSERM U955, Translational Psychiatry laboratory, AP-HP, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil, Créteil, France.,INSERM U894, AP-HP, Department of Psychiatry, Louis Mourier Hospital, Paris Diderot University, Sorbonne Paris Cité, Faculté de médecine, Colombes, France
| | - Ophélia Godin
- Fondation FondaMental, Créteil, France.,INSERM U955, Translational Psychiatry laboratory, AP-HP, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil, Créteil, France
| | - Ewa Bulzacka
- Fondation FondaMental, Créteil, France.,INSERM U955, Translational Psychiatry laboratory, AP-HP, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil, Créteil, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France.,INSERM U894, AP-HP, Department of Psychiatry, Louis Mourier Hospital, Paris Diderot University, Sorbonne Paris Cité, Faculté de médecine, Colombes, France
| | - Jasmina Mallet
- Fondation FondaMental, Créteil, France.,INSERM U894, AP-HP, Department of Psychiatry, Louis Mourier Hospital, Paris Diderot University, Sorbonne Paris Cité, Faculté de médecine, Colombes, France
| | - Guillaume Fond
- Fondation FondaMental, Créteil, France.,EA 3279 : CEReSS -Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille Univ, Faculté de Médecine, Marseille, France
| | - Lore Brunel
- Fondation FondaMental, Créteil, France.,INSERM U955, Translational Psychiatry laboratory, AP-HP, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil, Créteil, France
| | - Méja Andrianarisoa
- Fondation FondaMental, Créteil, France.,INSERM U955, Translational Psychiatry laboratory, AP-HP, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil, Créteil, France
| | | | - Isabelle Chereau
- Fondation FondaMental, Créteil, France.,Clermont-Ferrand University Hospital, EA 7280 Auvergne University, BP 69, Clermont-Ferrand, France
| | - Hélène Denizot
- Fondation FondaMental, Créteil, France.,Clermont-Ferrand University Hospital, EA 7280 Auvergne University, BP 69, Clermont-Ferrand, France
| | - Romain Rey
- Fondation FondaMental, Créteil, France.,INSERM U1028, CNRS UMR 5292, Centre de Recherche en Neurosciences de Lyon, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, Claude Bernard Lyon 1 University, Bron Cedex, France
| | - Jean-Michel Dorey
- Fondation FondaMental, Créteil, France.,INSERM U1028, CNRS UMR 5292, Centre de Recherche en Neurosciences de Lyon, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, Claude Bernard Lyon 1 University, Bron Cedex, France
| | - Christophe Lançon
- Fondation FondaMental, Créteil, France.,Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | - Catherine Faget
- Fondation FondaMental, Créteil, France.,Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | - Paul Roux
- Fondation FondaMental, Créteil, France.,Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France.,Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France
| | - Julien Dubreucq
- Fondation FondaMental, Créteil, France.,Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - Sylvain Leignier
- Fondation FondaMental, Créteil, France.,Psychosocial Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France
| | - Delphine Capdevielle
- Fondation FondaMental, Créteil, France.,INSERM 1061, University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Montpellier, France
| | - Myrtille André
- Fondation FondaMental, Créteil, France.,INSERM 1061, University Department of Adult Psychiatry, La Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Montpellier, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France.,Department of Adult Psychiatry, Charles Perrens Hospital, University of Bordeaux, Bordeaux, France
| | - David Misdrahi
- Fondation FondaMental, Créteil, France.,Department of Adult Psychiatry, Charles Perrens Hospital, University of Bordeaux, Bordeaux, France
| | - Fabrice Berna
- Fondation FondaMental, Créteil, France.,INSERM U1114, Strasbourg University Hospital, University of Strasbourg, Federation of Translational Psychiatry, Strasbourg, France
| | - Pierre Vidailhet
- Fondation FondaMental, Créteil, France.,INSERM U1114, Strasbourg University Hospital, University of Strasbourg, Federation of Translational Psychiatry, Strasbourg, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,INSERM U955, Translational Psychiatry laboratory, AP-HP, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil, Créteil, France
| | - Franck Schürhoff
- Fondation FondaMental, Créteil, France.,INSERM U955, Translational Psychiatry laboratory, AP-HP, DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d'Addictologie des Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil, Créteil, France
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11
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Driver DI, Thomas S, Gogtay N, Rapoport JL. Childhood-Onset Schizophrenia and Early-onset Schizophrenia Spectrum Disorders: An Update. Child Adolesc Psychiatr Clin N Am 2020; 29:71-90. [PMID: 31708054 DOI: 10.1016/j.chc.2019.08.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The clinical severity, impact on development, and poor prognosis of childhood-onset schizophrenia may represent a more homogeneous group. Positive symptoms in children are necessary for the diagnosis, and hallucinations are more often multimodal. In healthy children and children with a variety of other psychiatric illnesses, hallucinations are not uncommon and diagnosis should not be based on these alone. Childhood-onset schizophrenia is an extraordinarily rare illness that is poorly understood but seems continuous with the adult-onset disorder. Once a diagnosis is confirmed, aggressive medication treatment combined with family education and individual counseling may prevent further deterioration.
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Affiliation(s)
- David I Driver
- Child Psychiatry Branch, National Institutes of Mental Health (NIMH), National Institutes Health (NIH), Building 10, Room 4N313C, 10 Center Drive, Bethesda, MD 20814, USA.
| | - Shari Thomas
- Healthy Foundations Group, 4350 East West Highway, Suite 200, Bethesda, Maryland 20814, USA
| | - Nitin Gogtay
- National Institutes Health (NIH), NSC Building, Room 6104, 6001 Executive Boulevard, Rockville, MD 20852, USA
| | - Judith L Rapoport
- National Institutes Health (NIH), Building 10-CRC, Room 6-5332, 10 Center Drive, Bethesda, MD 20814, USA
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12
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Li Y, Sun K, Liu D, Chen MX, Li G, Ma J, Zhang X. The Effects of Combined Social Cognition and Interaction Training and Paliperidone on Early-Onset Schizophrenia. Front Psychiatry 2020; 11:525492. [PMID: 33192646 PMCID: PMC7556232 DOI: 10.3389/fpsyt.2020.525492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The limitations associated with antipsychotics in early-onset schizophrenia patients have stimulated more interest in psychological interventions in this population. Nevertheless, the isolated psychosocial interventions are unrealistic in a treatment success covering the complex array of symptoms, and the psychosocial interventions could be an adjunct treatment to the pharmacological treatment. It is necessary to find the benefits of psychological interventions with limited and targeted use of antipsychotics. Social cognition and interaction training (SCIT) was a program for social cognitive rehabilitation in adult schizophrenia. However, it is unclear how generalizable this is to early-onset patients. METHODS The current study tested this hypothesis that combined SCIT and paliperidone was superior to paliperidone alone in treating early-onset schizophrenia patients on cognitive, functional, and symptom outcomes. Two hundred eight inpatients with schizophrenia aged 13 to 17 years old participated in a 24-week work intervention program. Patients completed a battery of measures administered at a pre-SCIT intervention baseline, 4, 8, 12, and 24 weeks post-SCIT, respectively. RESULTS SCIT had significant added benefits above paliperidone for the speed of processing, attention/vigilance, and social cognition of the Chinese version of MATRICS consensus cognitive battery (MCCB) domains (p<0.05). The following logistic regression analysis on the exploration of the influential factors also confirmed the effects of SCIT. However, combined SCIT and paliperidone intervention had a null impact on social functioning and symptomatology. CONCLUSIONS The present study provides the first evidence that combined SCIT and paliperidone intervention has the potential to improve cognitive functions for the early-onset schizophrenia patients. The findings in the current study are suggestive of the extreme importance of SCIT as an adjunctive treatment in early-onset schizophrenia patients.
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Affiliation(s)
- Yichen Li
- Department of Child & Adolescent Psychiatry, Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Ke Sun
- Department of Child & Adolescent Psychiatry, Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Denghua Liu
- Department of Psychiatry, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Mo-Xian Chen
- School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Guo Li
- Department of Psychiatry, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Jun Ma
- Department of Child & Adolescent Psychiatry, Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Xiaofan Zhang
- Department of Psychiatry, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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13
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11th International Congress on Psychopharmacology & 7th International Symposium on Child and Adolescent Psychopharmacology. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1606883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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14
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Hsu CW, Lee SY, Wang LJ. Gender differences in the prevalence, comorbidities and antipsychotic prescription of early-onset schizophrenia: a nationwide population-based study in Taiwan. Eur Child Adolesc Psychiatry 2019; 28:759-767. [PMID: 30382356 DOI: 10.1007/s00787-018-1242-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 10/20/2018] [Indexed: 01/13/2023]
Abstract
Early-onset schizophrenia (EOS) is defined as patients diagnosed with schizophrenia before the age of 18. Whether the EOS population has gender differences is currently a matter of considerable debate. This study used a representative nationwide sample to examine potential gender differences in the prevalence, comorbidities, and prescription of antipsychotics among the EOS population. We identified a total of 401 patients with EOS (200 males and 201 females) from Taiwan's National Health Insurance Database between 2000 and 2012. The annual prevalence rate of overall patients with EOS increased significantly from 17.1 to 41.8 per 100,000 persons among the youth population (≤ 18 years). Sulpiride, Risperidone, and Aripiprazole were the most common antipsychotics of first choice for treating EOS. Compared to female patients, male patients were more likely to experience the following comorbidities: attention deficit hyperactivity disorder (15.5% vs. 5.5%), autism spectrum disorder (10.0% vs. 3.0%), intellectual disability (19.0% vs. 10.4%), developmental disorder (8.0% vs. 3.0%), and history of physical injury (65.5% vs. 48.8%), prior to being diagnosed with schizophrenia. We observed no significant gender differences with regard to incidence, prevalence, age of onset, and categories and doses of patients' first antipsychotic prescription. Our findings did not support the empirical opinion that males with EOS experience the onset earlier or are more prevalent than EOS female patients. However, male patients were more likely to have neurodevelopmental comorbidities and a history of physical injury. These results can function as an important reference for planning services that target real-world patient treatment.
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Affiliation(s)
- Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, College of Medicine, Graduate Institute of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Liang-Jen Wang
- Chang Gung University College of Medicine, Kaohsiung, Taiwan.
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, No. 123, Ta-Pei Road, Kaohsiung, Taiwan.
- Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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15
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Bliksted V, Samuelsen E, Sandberg K, Bibby BM, Overgaard MS. Discriminating between first- and second-order cognition in first-episode paranoid schizophrenia. Cogn Neuropsychiatry 2017; 22:95-107. [PMID: 28005458 DOI: 10.1080/13546805.2016.1268954] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION An impairment of visually perceiving backward masked stimuli is commonly observed in patients with schizophrenia, yet it is unclear whether this impairment is the result of a deficiency in first or higher order processing and for which subtypes of schizophrenia it is present. METHODS Here, we compare identification (first order) and metacognitive (higher order) performance in a visual masking paradigm between a highly homogenous group of young first-episode patients diagnosed with paranoid schizophrenia (N = 11) to that of carefully matched healthy controls (N = 13). RESULTS We find no difference across groups in first-order performance, but find a difference in metacognitive performance, particularly for stimuli with relatively high visibility. CONCLUSIONS These results indicate that the masking deficit is present in first-episode patients with paranoid schizophrenia, but that it is primarily an impairment of metacognition.
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Affiliation(s)
- Vibeke Bliksted
- a Psychosis Research Unit , Aarhus University Hospital Risskov , Risskov , Denmark.,b Interactive Minds Centre , Aarhus University , Aarhus C , Denmark
| | - Erla Samuelsen
- c Early Intervention Team, Region of Southern Denmark , Aabenraa , Denmark
| | - Kristian Sandberg
- d CNRU, CFIN , Aarhus University , Aarhus C , Denmark.,e Hammel Neurorehabilitation Centre and University Research Clinic , Aarhus University , Hammel , Denmark
| | - Bo Martin Bibby
- f Department of Biostatistics , Aarhus University , Aarhus C , Denmark
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16
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Stentebjerg-Olesen M, Pagsberg AK, Fink-Jensen A, Correll CU, Jeppesen P. Clinical Characteristics and Predictors of Outcome of Schizophrenia-Spectrum Psychosis in Children and Adolescents: A Systematic Review. J Child Adolesc Psychopharmacol 2016; 26:410-27. [PMID: 27136403 DOI: 10.1089/cap.2015.0097] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Treatment of early-onset schizophrenia spectrum psychosis (EOS) is hampered by limited data on clinical presentation and illness course. We aimed to systematically review the clinical characteristics, diagnostic trajectories, and predictors of illness severity and outcomes of EOS. METHODS We conducted a systematic PubMed, PsycINFO, and Embase literature review including studies published from January 1, 1990 to August 8, 2014 of EOS patients with 1) ≥50% nonaffective psychosis cases; 2) mean age of subjects <19 years; 3) clinical samples recruited through mental health services; 4) cross-sectional or prospective design; 5) ≥20 participants at baseline; 6) standardized/validated diagnostic instruments; and 7) quantitative psychotic symptom frequency or severity data. Exploratory analyses assessed associations among relevant clinical variables. RESULTS Across 35 studies covering 28 independent samples (n = 1506, age = 15.6 years, age at illness onset = 14.5 years, males = 62.3%, schizophrenia-spectrum disorders = 89.0%), the most frequent psychotic symptoms were auditory hallucinations (81.9%), delusions (77.5%; mainly persecutory [48.5%], referential [35.1%], and grandiose [25.5%]), thought disorder (65.5%), bizarre/disorganized behavior (52.8%), and flat or blunted affect/negative symptoms (52.3%/50.4%). Mean baseline Positive and Negative Syndrome Scale (PANSS)-total, positive, and negative symptom scores were 84.5 ± 10.9, 19.3 ± 4.4 and 20.8 ± 2.9. Mean baseline Clinical Global Impressions-Severity and Children's Global Assessment Scale/Global Assessment of Functioning (CGAS/GAF) scores were 5.0 ± 0.7 and 35.5 ± 9.1. Comorbidity was frequent, particularly posttraumatic stress disorder (34.3%), attention-deficit/hyperactivity and/or disruptive behavior disorders (33.5%), and substance abuse/dependence (32.0%). Longer duration of untreated psychosis (DUP) predicted less CGAS/GAF improvement (p < 0.0001), and poor premorbid adjustment and a diagnosis of schizophrenia predicted less PANSS negative symptom improvement (p = 0.0048) at follow-up. Five studies directly comparing early-onset with adult-onset psychosis found longer DUP in EOP samples (18.7 ± 6.2 vs. 5.4 ± 3.1 months, p = 0.0027). CONCLUSIONS EOS patients suffer substantial impairment from significant levels of positive and negative symptoms. Although symptoms and functioning improve significantly over time, pre-/and comorbid conditions are frequent, and longer DUP and poorer premorbid adjustment is associated with poorer illness outcome.
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Affiliation(s)
- Marie Stentebjerg-Olesen
- 1 Child and Adolescent Mental Health Center , Mental Health Services, the Capital Region of Denmark, Copenhagen, Denmark .,2 Faculty of Health Science, University of Copenhagen , Copenhagen, Denmark
| | - Anne K Pagsberg
- 1 Child and Adolescent Mental Health Center , Mental Health Services, the Capital Region of Denmark, Copenhagen, Denmark .,2 Faculty of Health Science, University of Copenhagen , Copenhagen, Denmark
| | - Anders Fink-Jensen
- 3 Mental Health Center, Copenhagen University Hospital , Copenhagen, Denmark .,4 Laboratory of Neuropsychiatry, Department of Neuroscience and Pharmacology, University of Copenhagen , Copenhagen, Denmark
| | - Christoph U Correll
- 5 Department of Psychiatry, The Zucker Hillside Hospital , North Shore - Long Island Jewish Health System, Glen Oaks, New York.,6 Department of Psychiatry and Molecular Medicine, Hofstra North Shore-LIJ School of Medicine , Hempstead, New York.,7 The Feinstein Institute for Medical Research , Manhasset, New York.,8 Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine , Bronx, New York
| | - Pia Jeppesen
- 1 Child and Adolescent Mental Health Center , Mental Health Services, the Capital Region of Denmark, Copenhagen, Denmark .,2 Faculty of Health Science, University of Copenhagen , Copenhagen, Denmark
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17
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Barkl SJ, Lah S, Starling J, Hainsworth C, Harris AWF, Williams LM. Facial emotion identification in early-onset psychosis. Schizophr Res 2014; 160:150-6. [PMID: 25464918 DOI: 10.1016/j.schres.2014.10.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/21/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
Abstract
Facial emotion identification (FEI) deficits are common in patients with chronic schizophrenia and are strongly related to impaired functioning. The objectives of this study were to determine whether FEI deficits are present and emotion specific in people experiencing early-onset psychosis (EOP), and related to current clinical symptoms and functioning. Patients with EOP (n=34, mean age=14.11, 53% female) and healthy controls (HC, n=42, mean age 13.80, 51% female) completed a task of FEI that measured accuracy, error pattern and response time. Relative to HC, patients with EOP (i) had lower accuracy for identifying facial expressions of emotions, especially fear, anger and disgust, (ii) were more likely to misattribute other emotional expressions as fear or disgust, and (iii) were slower at accurately identifying all facial expressions. FEI accuracy was not related to clinical symptoms or current functioning. Deficits in FEI (especially for fear, anger and disgust) are evident in EOP. Our findings suggest that while emotion identification deficits may reflect a trait susceptibility marker, functional deficits may represent a sequelae of illness.
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Affiliation(s)
- Sophie J Barkl
- School of Psychology, University of Sydney, NSW, Australia; The Brain Dynamics Centre, Sydney Medical School and Westmead Millennium Institute, University of Sydney, NSW, Australia; ARC Centre of Excellence in Cognition and Its Disorders, Sydney, NSW, Australia
| | - Suncica Lah
- School of Psychology, University of Sydney, NSW, Australia; ARC Centre of Excellence in Cognition and Its Disorders, Sydney, NSW, Australia
| | - Jean Starling
- Walker Unit, Concord Centre for Mental Health, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Cassandra Hainsworth
- Department of Psychological Medicine, The Children's Hospital, Westmead, NSW, Australia
| | - Anthony W F Harris
- The Brain Dynamics Centre, Sydney Medical School and Westmead Millennium Institute, University of Sydney, NSW, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Leanne M Williams
- The Brain Dynamics Centre, Sydney Medical School and Westmead Millennium Institute, University of Sydney, NSW, Australia; Psychiatry and Behavioral Sciences, Stanford University, CA, USA.
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18
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Abstract
BACKGROUND Schizophrenia often presents in adolescence, but current treatment guidelines are based largely on studies of adults with psychosis. Over the past decade, the number of studies on treatment of adolescent-onset psychosis has increased. The current systematic review collates and critiques evidence obtained on the use of various atypical antipsychotic medications for adolescents with psychosis. OBJECTIVES To investigate the effects of atypical antipsychotic medications in adolescents with psychosis. We reviewed in separate analyses various comparisons of atypical antipsychotic medications with placebo or a typical antipsychotic medication or another atypical antipsychotic medication or the same atypical antipsychotic medication but at a lower dose. SEARCH METHODS We searched the Cochrane Schizophrenia Group Register (October 2011), which is based on regular searches of BIOSIS, CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected references of all identified studies and contacted study authors and relevant pharmaceutical companies to ask for more information. SELECTION CRITERIA We included all relevant randomised controlled trials (RCTs) that compared atypical antipsychotic medication with placebo or another pharmacological intervention or with psychosocial interventions, standard psychiatric treatment or no intervention in children and young people aged 13 to 18 years with a diagnosis of schizophrenia, schizoaffective disorder, acute and transient psychoses or unspecified psychosis. We included studies published in English and in other languages that were available in standardised databases. DATA COLLECTION AND ANALYSIS Review authors AK and SSD selected the studies, rated the quality of the studies and performed data extraction. For dichotomous data, we estimated risk ratios (RRs) with 95% confidence intervals (CIs) using a fixed-effect model. When possible, for binary data presented in the 'Summary of findings' table, we calculated illustrative comparative risks. We summated continuous data using the mean difference (MD). Risk of bias was assessed for included studies. MAIN RESULTS We included 13 RCTs, with a total of 1112 participants. We found no data on service utilisation, economic outcomes, behaviour or cognitive response. Trials were classified into the following groups. 1. Atypical antipsychotics versus placebo: Only two studies compared one atypical antipsychotic medication with placebo. In one study, the number of non-responders treated with olanzapine was not different from the number treated with placebo (1 RCT, n = 107, RR 0.84, 95% CI 0.65 to 1.10); however, significantly more (57% vs 32%) people left the study early (1 RCT, n = 107, RR 0.56, 95% CI 0.36 to 0.87) from the placebo group compared with the olanzapine group. With regard to adverse effects, young people treated with aripiprazole had significantly lower serum cholesterol compared with those given placebo (1 RCT, n = 302, RR 3.77, 95% CI 1.88 to 7.58). 2. Atypical antipsychotics versus typical antipsychotics: When the findings of all five trials comparing atypical antipsychotic medications with a typical antipsychotic medication were collated, no difference in the mean end point Brief Psychiatric Rating Scale (BPRS) score was noted between the two arms (5 RCTs, n = 236, MD -1.08, 95% CI -3.08 to 0.93). With regard to adverse effects, the mean end point serum prolactin concentration was much higher than the reference range for treatment with risperidone, olanzapine and molindone in one of the studies. However, fewer adolescents who were receiving atypical antipsychotic medications left the study because of adverse effects (3 RCTs, n = 187, RR 0.65, 95% CI 0.36 to 1.15) or for any reason (3 RCTs, n = 187, RR 0.62, 95% CI 0.39 to 0.97).3. One atypical antipsychotic versus another atypical antipsychotic: The mean end point BPRS score was not significantly different for people who received risperidone compared with those who received olanzapine; however, the above data were highly skewed. Overall no difference was noted in the number of people leaving the studies early because of any adverse effects between each study arm in the three studies comparing olanzapine and risperidone (3 RCTs, n = 130, RR 1.15, 95% CI 0.44 to 3.04). Specific adverse events were not reported uniformly across the six different studies included in this section of the review; therefore it was difficult to do a head-to-head comparison of adverse events for different atypical antipsychotic medications.4. Lower-dose atypical antipsychotic versus standard/higher-dose atypical antipsychotic: Three studies reported comparisons of lower doses of the atypical antipsychotic medication with standard/higher doses of the same medication. One study reported better symptom reduction with a standard dose of risperidone as compared with a low dose (1 RCT, n = 257, RR -8.00, 95% CI -13.75 to -2.25). In another study, no difference was reported in the number of participants not achieving remission between the group receiving 10 mg/d and those who received 30 mg/d of aripiprazole (1 RCT, n = 196, RR 0.84, 95% CI 0.48 to 1.48). Similarly in the other study, authors reported no statistically significant difference in clinical response between the two groups receiving lower-dose (80 mg/d) and higher-dose (160 mg/d) ziprasidone, as reflected by the mean end point BPRS score (1 RCT, n = 17, MD -4.40, 95% CI -19.20 to 10.40). AUTHORS' CONCLUSIONS No convincing evidence suggests that atypical antipsychotic medications are superior to typical medications for the treatment of adolescents with psychosis. However, atypical antipsychotic medications may be more acceptable to young people because fewer symptomatic adverse effects are seen in the short term. Little evidence is available to support the superiority of one atypical antipsychotic medication over another, but side effect profiles are different for different medications. Treatment with olanzapine, risperidone and clozapine is often associated with weight gain. Aripiprazole is not associated with increased prolactin or with dyslipidaemia. Adolescents may respond better to standard-dose as opposed to lower-dose risperidone, but for aripiprazole and ziprasidone, lower doses may be equally effective. Future trials should ensure uniform ways of reporting.
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Affiliation(s)
- Ajit Kumar
- Leeds and York Partnership NHS Foundation TrustPsychiatryLinden House, St Mary's HospitalGreen Hill RoadLeedsUKLS12 3QE
| | - Soumitra S Datta
- Institute of Psychiatry, King's College LondonChild & Adolescent PsychiatryDe Crespigny ParkLondonUKSE5 8AF
- Tata Medical CentreDepartment of Palliative Care & Psycho‐oncologyMajor Arterial RoadRajarahat, New TownKolkataWest BengalIndia700156
| | - Stephen D Wright
- Leeds Partnerships NHS Foundation TrustCentral & North West Community Mental Health TeamMalham House25 Hyde TerraceLeedsWest YorkshireUKLS2 9LN
| | - Vivek A Furtado
- Institute of Mental HealthForensic PsychiatryThe University of NottinghamNottinghamNottinghamshireUKNG7 2TU
| | - Paul S Russell
- Christian Medical CollegeChild & Adolescent PsychiatryBagayamVelloreTamil NaduIndia632002
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Driver DI, Gogtay N, Rapoport JL. Childhood onset schizophrenia and early onset schizophrenia spectrum disorders. Child Adolesc Psychiatr Clin N Am 2013; 22:539-55. [PMID: 24012072 PMCID: PMC3771646 DOI: 10.1016/j.chc.2013.04.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The clinical severity, impact on development, and poor prognosis of childhood onset schizophrenia may represent a more homogeneous group. Positive symptoms in children are necessary for the diagnosis and hallucinations are more often multimodal. In healthy children and children with a variety of other psychiatric illnesses, hallucinations are not uncommon and diagnosis should not be based on these alone. Childhood onset schizophrenia is an extraordinarily rare illness that is poorly understood but seems continuous with the adult onset disorder. Once a diagnosis is affirmed, aggressive medication treatment combined with family education and individual counseling may defer further deterioration.
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Affiliation(s)
- David I. Driver
- Child Psychiatry Branch, National Institutes Health (NIH)/National Institutes of Mental Health (NIMH), Building 10, Room 3N202, 10 Center Drive, MSC 1600, Bethesda, 20892-1600
| | - Nitin Gogtay
- Child Psychiatry Branch, National Institutes Health (NIH)/National Institutes of Mental Health (NIMH), Building 10, Room 3N202, 10 Center Drive, MSC 1600, Bethesda, 20892-1600
| | - Judith L. Rapoport
- Child Psychiatry Branch, National Institutes Health (NIH)/National Institutes of Mental Health (NIMH), Building 10, Room 3N202, 10 Center Drive, MSC 1600, Bethesda, 20892-1600
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Jepsen JRM, Fagerlund B, Pagsberg AK, Christensen AMR, Nordentoft M, Mortensen EL. Profile of cognitive deficits and associations with depressive symptoms and intelligence in chronic early-onset schizophrenia patients. Scand J Psychol 2013; 54:363-70. [DOI: 10.1111/sjop.12062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 03/07/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Birgitte Fagerlund
- Lundbeck Foundation Centre for Clinical Intervention and Neuropsychiatric Schizophrenia; Research and Center for Neuropsychiatric Schizophrenia Research; Psychiatric Centre Glostrup; Copenhagen University Hospital Glostrup; Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Psychiatric Center Bispebjerg; Copenhagen University Hospital Bispebjerg; Denmark
| | | | - Merete Nordentoft
- Psychiatric Center Copenhagen; Copenhagen University Hospital Bispebjerg; Denmark
| | - Erik Lykke Mortensen
- Institute of Public Health and Center for Healthy Aging; University of Copenhagen; Denmark
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Maloney AE, Yakutis LJ, Frazier JA. Empirical evidence for psychopharmacologic treatment in early-onset psychosis and schizophrenia. Child Adolesc Psychiatr Clin N Am 2012; 21:885-909. [PMID: 23040906 DOI: 10.1016/j.chc.2012.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Psychotic symptoms presenting in youth can be clinically complex and require that a child and adolescent psychiatrist use significant skill in making a diagnosis and initiating treatment. There are a number of illnesses to rule out before making a diagnosis of early-onset schizophrenia in particular. Psychosis in youth has significant associated morbidity and places high demands not only on families but also on the medical and educational systems. More effective pharmacologic and nonpharmacologic treatments for psychosis are needed. Nonpharmacologic therapies targeting relatively treatment-resistant domains of dysfunction such as neurocognition are also necessary as adjunctive treatments to our extant pharmacologic agents.
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Affiliation(s)
- Ann E Maloney
- Department of Psychiatry, Child and Adolescent NeuroDevelopment Initiative (CANDI), University of Massachusetts Memorial Health Care, University of Massachusetts Medical School, Worcester, MA, USA.
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Abstract
BACKGROUND The current review analyzes the long-term outcome and prognosis of early onset schizophrenia based on previously published studies in 1980. METHODS A systematic search of articles published in the English-language literature after 1980 identified a total of 21 studies, which included 716 patients who were either suffering from early onset schizophrenia (EOS) or both EOS and other psychotic disorders (MIX). The authors of the current review scored the outcome as either "good," "moderate," or "poor." The mean age of onset in these studies was <18 years. RESULTS In general, the outcome in studies with EOS is worse than the outcome in MIX studies. Only 15.4% of the patients in EOS studies versus 19.6% of the patients in MIX studies experienced a "good" outcome. In contrast, 24.5% of the patients in EOS studies versus 33.6% in MIX studies experienced a "moderate" outcome, and 60.1% in EOS studies versus 46.8% in MIX studies experienced a "poor" outcome. The authors identified various significant effects on outcome. In EOS, the findings were significantly affected by sample attrition, indicating that in studies with a high dropout rate, fewer patients experienced a "moderate" outcome, and more patients experienced a "poor" outcome; however, the effect sizes were small. Furthermore, the effects were also small and more favourable for specific functioning measures, as opposed to more global measures, small to moderate in terms of worse outcomes for follow-up periods >10 years, small to moderate for more unfavourable outcomes in males, and small to large for worse outcomes in studies including patients diagnosed before 1970. CONCLUSIONS In contrast to the adult manifestation, the early manifestation of schizophrenia in childhood and adolescence still carries a particularly poor prognosis. According to these aggregated data analyses, longer follow-up periods, male sex, and patients having been diagnosed before 1970 contribute predominantly to the rather poor course of EOS.
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Helenius D, Munk-Jørgensen P, Steinhausen HC. Family load estimates of schizophrenia and associated risk factors in a nation-wide population study of former child and adolescent patients up to forty years of age. Schizophr Res 2012; 139:183-8. [PMID: 22704640 DOI: 10.1016/j.schres.2012.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 04/25/2012] [Accepted: 05/11/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This nation-wide register-based study investigates the family load of schizophrenia (SZ) across three generations in affected families compared to control families. Furthermore the study compares the family load in case vs. control families considering the age of onset of the disorder in the cases. In addition, the study addresses the impact of certain socio-demographic risk factors, i.e. sex, region of residence, year of birth, month of birth, and maternal and paternal age at birth. METHOD A total of N=2020 child and adolescent psychiatric cases born between 1969 and 1985 registered in the Danish Central Psychiatric Register (DCPR) before the age of 18 developed SZ before the age of 40. N=5982 controls without any psychiatric diagnosis before age 18 were matched for age, sex, and residential region. Psychiatric diagnoses were also obtained on the first-degree relatives, i.e. parents, siblings, and offspring as a part of the Danish Three Generation Study (3GS). A family load was obtained by using various mixed regression models. RESULTS SZ did occur more often in case than in control families. Having a mother, father or a sibling with the disorder was proven to be a risk factor. The year of birth, the region of residence, and paternal age at birth (≥ 35) were associated with SZ. However, the family load was not dependent on age of onset of the case-proband. Furthermore, case relatives did not develop SZ earlier than control relatives. CONCLUSIONS These findings based on a very large and representative dataset provide further and solid evidence for the high family aggregation of SZ. The year of birth, the region of residence, and paternal age at birth play an additional role in the development of the disorder.
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Affiliation(s)
- Dorte Helenius
- Research Unit for Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aarhus University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark.
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Crespi BJ, Crofts HJ. Association testing of copy number variants in schizophrenia and autism spectrum disorders. J Neurodev Disord 2012; 4:15. [PMID: 22958593 PMCID: PMC3436704 DOI: 10.1186/1866-1955-4-15] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 05/30/2012] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Autism spectrum disorders and schizophrenia have been associated with an overlapping set of copy number variant loci, but the nature and degree of overlap in copy number variants (deletions compared to duplications) between these two disorders remains unclear. METHODS We systematically evaluated three lines of evidence: (1) the statistical bases for associations of autism spectrum disorders and schizophrenia with a set of the primary CNVs thus far investigated, from previous studies; (2) data from case series studies on the occurrence of these CNVs in autism spectrum disorders, especially among children, and (3) data on the extent to which the CNVs were associated with intellectual disability and developmental, speech, or language delays. We also conducted new analyses of existing data on these CNVs in autism by pooling data from seven case control studies. RESULTS Four of the CNVs considered, dup 1q21.1, dup 15q11-q13, del 16p11.2, and dup 22q11.21, showed clear statistical evidence as autism risk factors, whereas eight CNVs, del 1q21.1, del 3q29, del 15q11.2, del 15q13.3, dup 16p11.2, dup 16p13.1, del 17p12, and del 22q11.21, were strongly statistically supported as risk factors for schizophrenia. Three of the CNVs, dup 1q21.1, dup 16p11.2, and dup 16p13.1, exhibited statistical support as risk factors for both autism and schizophrenia, although for each of these CNVs statistical significance was nominal for tests involving one of the two disorders. For the CNVs that were statistically associated with schizophrenia but were not statistically associated with autism, a notable number of children with the CNVs have been diagnosed with autism or ASD; children with these CNVs also demonstrate a high incidence of intellectual disability and developmental, speech, or language delays. CONCLUSIONS These findings suggest that although CNV loci notably overlap between autism and schizophrenia, the degree of strongly statistically supported overlap in specific CNVs at these loci remains limited. These analyses also suggest that relatively severe premorbidity to CNV-associated schizophrenia in children may sometimes be diagnosed as autism spectrum disorder.
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Affiliation(s)
- Bernard J Crespi
- Department of Biosciences, Simon Fraser University, Burnaby, BC, V5A 1 S6, Canada
| | - Helen J Crofts
- Department of Biosciences, Simon Fraser University, Burnaby, BC, V5A 1 S6, Canada
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Affiliation(s)
- Stephen D Wright
- Leeds Partnerships NHS Foundation Trust; Central & North West Community Mental Health Team; Malham House 25 Hyde Terrace Leeds West Yorkshire UK LS2 9LN
| | - Soumitra S Datta
- Institute of Psychiatry, Kings College London; Department of Child and Adolescent Psychiatry PO85; De Crespigny Park London UK SE5 8AF
| | - Ajit Kumar
- University of Leeds; School of Medicine; 5 Willow Avenue Leeds UK LS4 2HF
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Datta SS, Kumar A, Wright SD, Russell P. Typical antipsychotics for psychosis in adolescents. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Soumitra S Datta
- Institute of Psychiatry, Kings College London; Department of Child and Adolescent Psychiatry PO85; De Crespigny Park London UK SE5 8AF
| | - Ajit Kumar
- University of Leeds; School of Medicine; 5 Willow Avenue Leeds UK LS4 2HF
| | - Stephen D Wright
- Leeds Partnerships NHS Foundation Trust; Central & North West Community Mental Health Team; Malham House 25 Hyde Terrace Leeds West Yorkshire UK LS2 9LN
| | - Paul Russell
- Christian Medical College; Child & Adolescent Psychiatry; Vellore Tamil Nadu India 632002
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Walker DM, Standen PJ. Level and pattern of neuropsychological functioning in early-onset psychoses. Eur Child Adolesc Psychiatry 2011; 20:551-60. [PMID: 21989901 DOI: 10.1007/s00787-011-0219-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 09/21/2011] [Indexed: 11/30/2022]
Abstract
The present study aimed to compare the level and pattern of cognitive deficits in patients with early-onset psychoses with an age, gender and IQ matched control group. In order to ensure a representative sample of patients with psychoses, participants with an IQ of less than 70 were included. Forty-eight patients with an onset of psychoses before the age of 16, and 47 age, gender and IQ matched controls without psychoses were recruited. Psychotic symptomatology was assessed using the Schedules for Clinical Assessment to obtain DSM-IV and ICD-10 diagnoses. Positive and negative symptoms were assessed using the Positive and Negative Symptoms Scale. Levels of cognitive function were measured using a comprehensive neuropsychological battery. A pattern of specific impairments was not found, with few significant differences between the two cohorts. However both cohort groups performed lower than age derived norms. Therefore it appears that there are global cognitive deficits rather than specific deficits in early-onset psychoses when compared to normative data, in-line with conclusions of early-onset schizophrenia research, but patients did not have greater deficit than controls when matched on IQ, gender and age, even after excluding participants with IQ less than 70.
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Affiliation(s)
- D-M Walker
- Division of Child and Adolescent Psychiatry, Medical School, Queen's Medical Centre, University of Nottingham, UK.
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El-Badri S, Mellsop G. Clozapine use and outcomes among patients with treatment resistant schizophrenia. Australas Psychiatry 2011; 19:410-4. [PMID: 21864010 DOI: 10.3109/10398562.2011.602078] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The phenomenology of patients with schizophrenia is similar world-wide, regardless of culture. However, the prognosis is variable both internationally and within national groups of patients. Furthermore, despite advances in pharmacological treatment, a significant proportion of patients with schizophrenia continue to show residual symptoms and disabilities due to poor response to antipsychotic medication. This study retrospectively assessed differences in outcome by gender, ethnicity and age among a group of treatment-resistant patients with schizophrenia. METHOD Patients in the catchment (350,000 people) of a single New Zealand public mental health provider (Waikato) formed the study group. Information concerning demographic profiles, Health of the Nation Outcome Scales (HoNOS) ratings and details of Clozapine usage were extracted from clinical records and the data base. RESULTS Gender, ethnicity and age did not emerge as significantly associated with any of the outcome variables except for the 30-40 year olds having more improvement on overactivity/aggression ratings than younger or older patients. CONCLUSIONS Despite these negative results in the New Zealand context, there remain many unanswered questions about the higher rate of service use by Maori. Replication of this study on a larger cohort of patients may be indicated before discarding the idea of potential links between ethnicity, treatment choice and outcomes.
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Affiliation(s)
- Selim El-Badri
- Adult Mental Health Service, Waikato District Health Board, Hamilton, New Zealand.
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Hassan GAM, Taha GRA. Long term functioning in early onset psychosis: two years prospective follow-up study. BEHAVIORAL AND BRAIN FUNCTIONS : BBF 2011; 7:28. [PMID: 21801438 PMCID: PMC3162891 DOI: 10.1186/1744-9081-7-28] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Accepted: 07/30/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND There were few studies on the outcome of schizophrenia in developing countries. Whether the outcome is similar to or different from developed world is still a point for research. The main aim of the current study was to know if patients with early onset non affective psychosis can behave and function properly after few years from start of the illness or not. Other aims included investigation of possible predictors and associated factors with remission and outcome. METHOD The study prospectively investigated a group of 56 patients with onset of psychosis during childhood or adolescence. Diagnosis made according to DSM-IV criteria and included; schizophrenia, psychotic disorder not otherwise specified and acute psychosis. Severity of psychosis was measured by PANSS. Measures of the outcome included; remission criteria of Andreasen et al 2005, the children's global assessment scale and educational level. RESULTS Analysis of data was done for only 37 patients. Thirty patients diagnosed as schizophrenia and 7 with Psychotic disorder not otherwise specified. Mean duration of follow up was 38.4 +/- 16.9 months. At the end of the study, 6 patients (16.2%) had one episode, 23 (62.1%) had multiple episodes and 8 (21.6%) continuous course. Nineteen patients (51.4%) achieved full remission, and only 11 (29.7%) achieved their average educational level for their age. Twenty seven percent of the sample had good outcome and 24.3% had poor outcome. Factors associated with non remission and poor outcome included gradual onset, low IQ, poor premorbid adjustment, negative symptoms at onset of the illness and poor adherence to drugs. Moreover, there was tendency of negative symptoms at illness start to predict poor outcome. CONCLUSION Some patients with early onset non affective psychosis can behave and function properly after few years from the start of the illness. Although remission is a difficult target in childhood psychosis, it is still achievable.
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Affiliation(s)
- Ghada AM Hassan
- Institute of Psychiatry, Ain Shams University, WHO Collaborating Center for Training and Research, Abbasia, Cairo, Egypt
| | - Ghada RA Taha
- Institute of Psychiatry, Ain Shams University, WHO Collaborating Center for Training and Research, Abbasia, Cairo, Egypt
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Jepsen JRM, Fagerlund B, Pagsberg AK, Christensen AMR, Nordentoft M, Mortensen EL. Deficient maturation of aspects of attention and executive functions in early onset schizophrenia. Eur Child Adolesc Psychiatry 2010; 19:773-86. [PMID: 20680364 DOI: 10.1007/s00787-010-0126-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Accepted: 07/12/2010] [Indexed: 11/24/2022]
Abstract
The few existing long-term, neuropsychological follow-up studies of early onset schizophrenia (EOS) patients have reported relative stability in some cognitive functions but abnormal developmental trajectories in verbal memory, set shifting, aspects of attention, and speed of information processing throughout late adolescence into early adulthood. The current 5-year follow-up study compared the development of specific cognitive functions in EOS patients (N = 17) from the time of first-episode to chronic phase with that of healthy controls (N = 38) and secondarily to patients with other early onset, non-organic, non-affective psychoses (EOP) (N = 11). Speed of processing of executive functions, set shifting, and attention improved significantly in the healthy controls and reflected continuous functional maturation during late adolescence and early adulthood. The developmental progression of attention and set shifting but not speed of processing of executive functions was significantly subnormal in EOS patients. Other specific cognitive functions that had attained functional maturity in the healthy controls before or around the time of the baseline assessment showed normal development in EOS patients during the follow-up period, indicating stable cognitive deficits. These results suggest post-onset developmental deficits in two out of the three aspects of attention and executive functions that have protracted maturational trajectories and that overlap the age of onset of EOS. No significant difference in the development of any specific cognitive function was found between the EOS and EOP group.
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Affiliation(s)
- Jens Richardt M Jepsen
- Child and Adolescent Psychiatric Centre Bispebjerg, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
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Kerbeshian J, Peng CZ, Burd L. Tourette syndrome and comorbid early-onset schizophrenia. J Psychosom Res 2009; 67:515-23. [PMID: 19913656 DOI: 10.1016/j.jpsychores.2009.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 08/06/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE A study of the shared phenomenology between Tourette syndrome (TS) and schizophrenia. METHOD An illustrative case report is presented. We used a chart review of 399 clinically ascertained patients with TS to identify 10 cases meeting criteria for schizophrenia. From our 10 patients, salient clinical characteristics were then tabulated. We then extracted similar clinical characteristics from a previously published series of patients with comorbid TS and schizophrenia in order to combine cases and allow for a comparison between childhood-onset schizophrenia (COS), adolescent-onset schizophrenia (AdolOS), and adult-onset schizophrenia (AduOS) cases in these groups. RESULTS We found 10 cases of schizophrenia (all were males) in the 399 TS patients for a prevalence rate of 2.5% (95% CI 0.96-4.04). Mean age of tic onset for TS diagnostic criteria ranged from 2-14 years with a mean of 8.2 years. The mean age of diagnosis for schizophrenia was 14.2 (range 9-23 years). We found six cases of schizophrenia with onset of positive psychotic symptoms by 13 years of age, two cases with onset after 13 years of age and before 18 years of age, and two cases with onset after 18 years of age. Attention deficit hyperactivity disorder was present at a higher rate (70%) than one would expect in a clinically ascertained group of patients with TS. Comparison between COS, AdolOS and AduOS in our pooled cases noted a sex bias skewed toward males. Catatonic symptoms may be more likely in child or adolescent onset cases and negative symptoms more likely in AduOS cases. CONCLUSIONS The 2.5% prevalence of schizophrenia in our TS sample exceeds the 1% expected rate of schizophrenia in the general population (chi-square=9.14; P=.0025). The six cases of COS (before 13 years of age) exceeds the expected rate of 1-2 per 100,000 (chi-square=4499; P=.0001). The 752-fold increase in observed rates of comorbid TS and COS over expected rates suggests a role for unknown common underlying etiologic factors. Based on clinical features, patients with TS and comorbid COS, AdolOS, or AduOS do not have different conditions. We conclude with suggestions for further research.
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Affiliation(s)
- Jacob Kerbeshian
- Department of Neuroscience, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202-9037, USA
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Margari F, Presicci A, Petruzzelli MG, Ventura P, Di Cuonzo F, Palma M, Margari L. Very early onset and greater vulnerability in schizophrenia: A clinical and neuroimaging study. Neuropsychiatr Dis Treat 2008; 4:825-30. [PMID: 19043525 PMCID: PMC2536548 DOI: 10.2147/ndt.s2484] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although schizophrenia has been diagnosed in children, this group of disorders has received too little attention in the clinical and research literature. Preliminary data suggest that early onset schizophrenia (EOS) and very early onset schizophrenia (VEOS) tend to have a worse outcome than adult onset schizophrenia, and seem to be related to a greater familial vulnerability, due to genetic, psychosocial, and environmental factors. Recently, advanced neuroimaging techniques have revealed structural and functional brain abnormalities in some cerebral areas. This paper reports on a case diagnosed as VEOS, with premorbid year-long psychopathological history. The patient showed atypical proton magnetic resonance spectroscopy findings, and normal brain and spine computer tomography and brain magnetic resonance images.
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Affiliation(s)
- Francesco Margari
- Department of Neurologic and Psychiatry Sciences, Psychiatry Unit, University of Bari Italy
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Fulton K, Short M, Harvey-Smith D, Rushe TM, Mulholland C. The Northern Ireland Early Onset Psychosis Study: Phenomenology and Co-morbidity in the First 25 Cases. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/13575270701868884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Frazier JA, McCLELLAN J, Findling RL, Vitiello B, Anderson R, Zablotsky B, Williams E, McNAMARA NK, Jackson JA, Ritz L, Hlastala SA, Pierson L, Varley JA, Puglia M, Maloney AE, Ambler D, Hunt-Harrison T, Hamer RM, Noyes N, Lieberman JA, Sikich L. Treatment of early-onset schizophrenia spectrum disorders (TEOSS): demographic and clinical characteristics. J Am Acad Child Adolesc Psychiatry 2007; 46:979-988. [PMID: 17667477 DOI: 10.1097/chi.0b013e31807083fd] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We examined baseline demographic and clinical profiles of youths enrolled from 2001 to 2006 in the publicly funded multicenter, randomized controlled trial Treatment of Early-Onset Schizophrenia Spectrum Disorders. METHOD Youths (8-19 years) with schizophrenia (SZ) and schizoaffective disorder were recruited at four academic sites. Diagnosis was made via structured and clinical interviews. Assessments of psychiatric symptoms and social and global functioning were included. RESULTS A total of 119 youths were enrolled. The mean age at illness onset was 11.1 +/- 3.5 years. Patients with SZ and schizoaffective disorder had similar ratings on the Positive and Negative Symptom Scale, Brief Psychiatric Rating Scale for Children, and Clinical Global Impression-Severity Scale. The overall level of functioning was similar in the two groups. A comparison to published reports of adults with SZ indicates that these youths may have more severe symptoms based on results of the Positive and Negative Symptom Scale. CONCLUSIONS This is one of the largest samples of youths with SZ spectrum disorders studied to date and the largest assessment of youths with schizoaffective disorder. High rates of symptoms and general psychopathology were noted. There was a substantial degree of social and functional impairment. The symptom profiles are consistent with, but more severe than, those reported in the adult literature.
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Affiliation(s)
- Jean A Frazier
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill..
| | - Jon McCLELLAN
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Robert L Findling
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Benedetto Vitiello
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Robert Anderson
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Benjamin Zablotsky
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Emily Williams
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Nora K McNAMARA
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Joseph A Jackson
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Louise Ritz
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Stefanie A Hlastala
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Leslie Pierson
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Jennifer A Varley
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Madeline Puglia
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Ann E Maloney
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Denisse Ambler
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Tyehimba Hunt-Harrison
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Robert M Hamer
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Nancy Noyes
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Jeffrey A Lieberman
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
| | - Linmarie Sikich
- Drs. Frazier and Jackson, Mr. Zablotsky, and Ms. Noyes are with the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Drs. McClellan and Hlastala, Ms. Pierson, and Ms. Varley are with the University of Washington, Seattle; Drs. Findling and McNamara are with the Case Western Reserve University, Cleveland; Dr. Vitiello and Ms. Ritz are with the National Institute of Mental Health, Bethesda, MD; Dr. Maloney is with the Maine Medical Center, Portland; Dr. Hunt-Harrison is with the John Umstead Hospital, Butner, NC; Dr. Lieberman is with Columbia University, New York; and Drs. Sikich, Hamer, and Ambler, Ms. Williams, Ms. Puglia, and Mr. Anderson are with the University of North Carolina at Chapel Hill
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Abstract
BACKGROUND Childhood-onset schizophrenia is schizophrenia with onset prior to the age of 13 years. Although it is rare, people who suffer from schizophrenia at an early age appear to have a clinically severe form of the illness with poor long-term prognosis. Antipsychotic medication is one way of managing this rare but serious mental illness. OBJECTIVES To examine the effects of antipsychotic medication for childhood-onset schizophrenia. SEARCH STRATEGY We searched the Cochrane Schizophrenia Group Trials Register (November 2006 and February 2007), inspected references of all identified studies for further trials and contacted relevant pharmaceutical companies and authors of trials for additional information. SELECTION CRITERIA We included all randomised clinical trials involving children and young people with a diagnosis of childhood onset schizophrenia (i.e. with a diagnosis of schizophrenia before the age of 13) comparing any antipsychotic drug with another antipsychotic or placebo. DATA COLLECTION AND ANALYSIS We reliably selected, quality assessed and extracted data from trials. We excluded data where more than 50% of participants in any group were lost to follow up. For homogenous dichotomous data we calculated random effects, relative risk (RR) and its 95% confidence interval (CI) and, where appropriate, number needed to treat (NNT) on an intention-to-treat basis. For normal continuous data we calculated the weighted mean difference (WMD). MAIN RESULTS From a total of 2062 citations, we identified six relevant trials. We categorised trials into three comparisons: atypical versus typical, atypical versus atypical and typical versus typical antipsychotic drugs. The only comparison to find any differences between treatment groups was atypical versus typical antipsychotic drugs. A few results from one study favoured the atypical antipsychotic clozapine over haloperidol in treating treatment resistant childhood-onset schizophrenia (n=21, WMD CGAS 17.00 CI 7.74 to 26.26; n=21, WMD Bunney-Hamburg Psychosis Rating Scale -3.60 CI -6.64 to -0.56). Participants on clozapine, however, were three times more likely to have drowsiness (1 RCT, n=21, RR 3.30 CI 1.23 to 8.85, NNH 2 CI 2 to 17) and half of the children receiving clozapine had neutropenia (1 RCT, n=21, RR 12, CI 0.75 to 192.86). AUTHORS' CONCLUSIONS There are few relevant trials and, presently, there is little conclusive evidence regarding the effects of antipsychotic medication for those with early onset schizophrenia. Some benefits were identified in using the atypical antipsychotic clozapine compared with haloperidol but the benefits were offset by an increased risk of serious adverse effects. Larger, more robust, trials are required.
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Affiliation(s)
- E Kennedy
- Tavistock Clinic, Child and Family Department, 120 Belsize Lane, Hampstead, London, UK, NW3 5BA.
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Malhotra S, Gupta N, Bhattacharya A, Kapoor M. Study of childhood onset schizophrenia (COS) using SPECT and neuropsychological assessment. Indian J Psychiatry 2006; 48:215-22. [PMID: 20703340 PMCID: PMC2915591 DOI: 10.4103/0019-5545.31552] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In recent years, the development of positron emission tomography (PET) and single-photon emission computed tomography (SPECT) imaging has enhanced our understanding of the physiological functioning of the intact brain. AIM To study cerebral cortical perfusion defects in patients with childhood onset schizophrenia (COS) and to assess their neuropsychological functioning. METHODS This cross-sectional study comprised 14 patients with COS with onset at or before 14 years of age, diagnosed as per ICD-10 DCR criteria, attending a tertiary care centre in North India. All the patients were assessed on sociodemographic, clinical profile sheet, Positive and Negative Symptom Scale (PANSS) and Edinburgh Handedness Inventory (EHI). The Wisconsin Card Sorting Test (WCST) was used to assess their neuropsychological functioning. All patients underwent SPECT. A control group of 10 healthy subjects was studied with SPECT for comparison. RESULTS Nine patients (64.3%) showed perfusion anomaly on SPECT scan specifically in the left temporal and frontal areas of the brain. On WCST score these 9 patients showed a higher percentage of total errors (64.49%+/-9.42%) as compared to the other 5 patients (48.54%+/-12.70%) who showed no abnormality on SPECT scan. All normal control subjects showed no abnormality on SPECT. CONCLUSION The results from WCST show that COS patients have difficulty in executive functioning. Also, patients had perfusion anomaly in the left temporal, frontal and parietal areas. Deficits found in COS are similar to those found in adult onset schizophrenia (AOS). In view of the findings, the nature of COS and its relationship with AOS are discussed.
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Affiliation(s)
- Savita Malhotra
- Professor, Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
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Bonnot O, Mazet P. Vulnérabilité aux schizophrénies à l'adolescence : revue de la littérature et applications cliniques. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.neurenf.2005.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Muratori F, Salvadori F, D'Arcangelo G, Viglione V, Picchi L. Childhood psychopathological antecedents in early onset schizophrenia. Eur Psychiatry 2006; 20:309-14. [PMID: 16018922 DOI: 10.1016/j.eurpsy.2005.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2004] [Accepted: 03/21/2005] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the premorbid state of early onset schizophrenia (EOS). METHODS Twenty-three adolescents with EOS were compared to a healthy control group (CG) and to a group of anorexic patients (AG). The premorbid state was studied through the CBCL and the data obtained were analyzed using ANOVA's and t-test. RESULTS During the premorbid period EOS showed significantly higher scores on all scales, relative to the CG, and only on some scales (social, thought and attention problems, and school competencies) relative to the AG. CONCLUSIONS Children who develop first episode psychosis during adolescence differ from children with normal development. The premorbid internalizing state is common to AG but social competencies and school problems are the most affected areas in EOS when compared to the AG. It is hypothesized that both EOS and AG can be considered as the expression of a previous vulnerability.
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Remschmidt H, Theisen FM. Schizophrenia and related disorders in children and adolescents. JOURNAL OF NEURAL TRANSMISSION. SUPPLEMENTUM 2006:121-41. [PMID: 16355606 DOI: 10.1007/3-211-31222-6_7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This paper reviews the concept and recent studies on childhood and adolescent psychoses with special reference to schizophrenia. After a short historical introduction, the definition, classification, and epidemiology of child- and adolescent-onset psychoses are described, pointing out that some early-onset psychotic states seem to be related to schizophrenia (such as infantile catatonia) and others not (such as desintegrative disorder). The frequency of childhood schizophrenia is less than 1 in 10,000 children, but there is a remarkable increase in frequency between 13 and 18 years of age. Currently, schizophrenia is diagnosed according to ICD-10 and DSM-IV criteria. The differential diagnosis includes autism, desintegrative disorder, multiplex complex developmental disorder (MCDD) respectively multiple developmental impairment (MDI), affective psychoses, Asperger syndrome, drug-induced psychosis and psychotic states caused by organic disorders. With regard to etiology, there is strong evidence for the importance of genetic factors and for neurointegrative deficits preceding the onset of the disorder. Treatment is based upon a multimodal approach including antipsychotic medication (mainly by atypical neuroleptics), psychotherapeutic measures, family-oriented measures, and specific measures of rehabilitation applied in about 30% of the patients after completion of inpatient treatment. The long-term course of childhood- and adolescent-onset schizophrenia is worse than in adulthood schizophrenia, and the patients with manifestation of the disorder below the age of 14 have a very poor prognosis.
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Affiliation(s)
- H Remschmidt
- Department of Child and Adolescent Psychiatry, Philipps-University, Marburg, Germany.
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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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Abstract
The study describes the psychopathological and social outcome of patients treated for schizophrenia in adolescence (mean age at onset 16.0 years/SD 1.52) after a mean follow-up period of 15.4 years (10.2-21.2 years). Out of 55 patients consecutively admitted to hospital, 47 (85 %) could be traced and 39 (71 %) could be re-examined. At follow-up, 33/39 patients (85 %) had had at least one readmission. Full remission of global psychopathological symptoms [Clinical Global Impression (CGI) <or= 2] was found in 3/39 (8 %),a moderate outcome (CGI=3-5) in 22/39 (56 %), and a poor outcome (CGI=6-8) was seen in 14/39 (36 %). Severe or very severe impairments of global social functioning [Global Assessment of Social Function (GAS)< 51] were observed in 20/39 (51 %). The best predictor of global psychopathological and psychosocial outcome was type of onset (CGI: Beta=0.36, GAS: Beta=-0.37). A poor outcome was seen in 22 out of 25 cases with insidious onset. All predictors together explained 58% of the variance in the Positive and Negative Syndrome (PANSS) negative symptom ratings at follow-up. Gender, duration of first inpatient treatment and duration of untreated psychosis were of no predictive value for outcome. The nature of the diagnosis in the first episode strongly predicted the diagnosis given for the whole course after 15 years. In 26/37 cases (70 %), diagnosis at onset and overall diagnoses were the same. Our finding of an incidence of 61% insidious onset is similar to that in adult onset schizophrenia (AOS), but different to very early onset schizophrenia (VEOS), which shows a higher rate of insidious onset, cognitive impairment and poor outcome. Therefore, it seems that VEOS is a special group compared with early onset schizophrenia (EOS) and AOS.
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Affiliation(s)
- Bernd Röpcke
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Rheinische Landes- und Hochschulklinik Essen, Virchowstrasse 174, 45147 Essen, Germany.
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Ballageer T, Malla A, Manchanda R, Takhar J, Haricharan R. Is adolescent-onset first-episode psychosis different from adult onset? J Am Acad Child Adolesc Psychiatry 2005; 44:782-9. [PMID: 16034280 DOI: 10.1097/01.chi.0000164591.55942.ea] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine whether first-episode psychosis patients with onset during adolescence (ages 15-18) differ significantly from those with young-adult onset (ages 19-30). METHOD Consecutive patients presenting with first-episode psychosis (N = 242) were assessed for demographic and illness characteristics such as duration of untreated psychosis, diagnosis, length of prodromal period, premorbid adjustment, level of psychotic, negative, depressive, anxiety, and extrapyramidal symptoms, and alcohol and drug use. RESULTS Eighty-two patients (40.8%) had an onset of psychosis during adolescence (ages 15-18) and 119 (59.2%) during young adulthood (ages 19-30). The adolescent-onset group experienced longer delays in treatment of psychosis (duration of untreated psychosis) (p < .02), showed modestly worse premorbid functioning during late adolescence (p < .05), and were more likely to present with bizarre behavior (p < .01) and primary negative symptoms (p < .01). CONCLUSIONS Patients with adolescent onset of psychosis are more likely to present with clinical characteristics that portend a poorer outcome and may require a different approach to early identification and treatment.
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Affiliation(s)
- Trevor Ballageer
- University of Manitoba, Mental Health Program, Health Sciences Centre, Winnipeg, Canada
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Asarnow JR. Childhood-onset schizotypal disorder: a follow-up study and comparison with childhood-onset schizophrenia. J Child Adolesc Psychopharmacol 2005; 15:395-402. [PMID: 16092906 DOI: 10.1089/cap.2005.15.395] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This paper presents results from the UCLA Follow-Up Study of Childhood-Onset Schizophrenia (SZ) Spectrum Disorders. METHOD We assessed 12 children with schizotypal personality disorder (SPD) and 18 children with schizophrenia 1-7 years following initial project intake. RESULTS There was significant continuity between SZ spectrum disorders in childhood and adolescence. Although not all children who presented initially with SZ spectrum disorders continued to meet criteria for SZ spectrum disorder as they progressed through the follow-up period, rates of SZ spectrum disorders ranged from 75% to 92% across the 3 follow-up years for children initially presenting with SPD, and from 78% to 89% for children initially presenting with SZ. CONCLUSION The most common clinical outcome for children with SPD was continuing SPD, supporting the hypothesis of continuity between childhood and later SPD. However, 25% of the SPD sample developed more severe SZ spectrum disorders (schizophrenia or schizoaffective disorder), also supporting the hypothesis that SPD represents a risk or precursor state for more severe SZ spectrum disorders.
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Datta SS. ECT treatment for autism: a viable alternative for a subgroup of patients? Med Hypotheses 2005; 64:219. [PMID: 15533648 DOI: 10.1016/j.mehy.2004.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2004] [Accepted: 08/16/2004] [Indexed: 11/23/2022]
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Bailly D, de Chouly de Lenclave MB. Un trouble rare et peu étudié : la schizophrénie chez l’enfant. À propos d’une observation. Encephale 2004; 30:540-7. [PMID: 15738856 DOI: 10.1016/s0013-7006(04)95468-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED Childhood-onset schizophrenia is rare: its prevalence is about 50 times lower than the one observed in adulthood. It is also frequently unrecognized, notably because its clinical aspect varies with age. The authors report the case of a prepubertal girl who developed a typical clinical picture of schizophrenia (paranoid subtype) by age 9. CASE REPORT The patient was 10 years old when she was hospitalized for a relapse of a suspected childhood-onset schizophrenia. Several significant mental disorders were found in her family history: her mother was treated for mood disorders (including dysthymia and major depression with postpartum onset), while her father and a aunt exhibited schizophrenic disorders. In addition, prenatal and perinatal events (including probable prenatal maternal infection and obstetric complications) were reported by her mother. Demonstrable impairments were already present in her premorbid development: from the age of 3.5, she showed significant manifestations of behavioural inhibition and separation anxiety, severe difficulties in social adaptation, and language abnormalities (qualified by her general practitioner as selective mutism). At the age of 9, when her mother was hospitalized for a diabetes mellitus, she suddenly showed auditory and visual hallucinations associated with delusions. Their content included filiation, somatic, and persecutory themes. Grossly disorganized behaviour (and more particularly catatonic motor behaviours including catatonic rigidity and negativism and bizarre postures) was also observed. Negative symptoms (eg anhedonia, affective flattening, and alogia) were noted. Her IQ scores were 74 in the verbal subtests and 53 in the performance subtests. Because the diagnostic of childhood-onset schizophrenia was suspected, a neuroleptic treatment, haloperidol 3 mg/day, was tried. After a partial remission during a few months period (characterized by a decrease in delusions, anxiety and sleep difficulties), she showed a relapse leading to her hospitalization. At the time of her admission, she showed severe manifestations of separation anxiety including agitation, anger, crying, and insomnia, for which she received a short-lived treatment by lorazepam. When sedation was obtained, the clinical picture proved similar to the one previously observed: hallucinations, delusions, grossly disorganized behaviour, and thought disorder were noted. As soon as the diagnostic of childhood-onset schizophrenia was confirmed, she was administered a new antipsychotic agent, amisulpride, at dose of 600 mg/day. This treatment was going on during several weeks with no significant clinical effect. Because the early onset of the disorder, the family history of schizophrenia, and the lack of effectiveness of the two previously administered antipsychotic agents, a treatment with clozapine was started at the dose of 12,5 mg/day. From the outset of this treatment, clinically significant reductions in hallucinations and disorganized behaviours were noted. Dose was then progressively increased until 200 mg/day, resulting in significant improvement in cognitive and motor functioning. The patient is now in an educational institute. Her adaptation is considered satisfactory, in spite of regular exacerbations of delusions in response to stressful life events. Treatment with clozapine is going on, without any significant undesirable clinical effects. DISCUSSION If an abrupt onset is rarely observed in prepubertal children, all the authors report that patients with very early onset schizophrenia show to have demonstrable impairments in their premorbid language as well as in their motor and social development. In addition, several studies suggest that more pronounced early developmental abnormalities are usually associated with a poor outcome in schizophrenia. The clinical picture also agrees with recent studies showing that in children paranoid subtype is as frequent as seen in adult disorders. If genetic factors play a significant role in the pathogenesis of schizophrenia, the notion that such factors may be more salient in very early onset and more severe cases is now usually accepted. However, a number of environmental factors, including prenatal maternal infections and perinatal complications, may also be implicated in the pathogenesis of schizophrenia, in addition to genetic factors. Because a significant relationship between stressful life events and exacerbations in positive symptoms was found in the case reported, the authors examine the role of such stress factors in the pathogenesis of schizophrenia and in the course of illness. A brief review of studies that have examined the effects of antipsychotic agents in children with schizophrenia underscores the paucity of data available to guide clinicians in this area. However, these data suggest that children who receive conventional neuroleptics experience significant adverse effects, primarily sedation and extrapyramidal symptoms. In addition, they suggest that new antipsychotic agents, such as clozapine, may be more effective than conventional neuroleptics, particularly in negative symptoms. Lastly, the authors emphasize the poor outcome usually reported in childhood-onset schizophrenia, highlighting the need of a long-term pharmacological and behavioural treatment. CONCLUSION This case report, such as others, supports the hypo-thesis that there is a clinical continuity between early and later onset schizophrenia. It also suggests that very early onset schizophrenia is a more severe form of the disorder and may be secondary to greater familial vulnerability. Consequently, systematic studies of these patients may be particularly informative and may provide important informations for understanding the etiologic processes involved in the pathogenesis of schizophrenia.
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Affiliation(s)
- D Bailly
- Fédération de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Sainte-Marguerite, 270 boulevard de Sainte-Marguerite, 13009 Marseille, France
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Friedlander RI, Donnelly T. Early-onset psychosis in youth with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2004; 48:540-547. [PMID: 15312054 DOI: 10.1111/j.1365-2788.2004.00622.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Accurate diagnosis of psychotic disorders may be very difficult in youth with intellectual disabilities. METHOD The authors reviewed the assessment, treatment and follow-up of 21 youths with ID referred because of early onset of psychotic symptoms. RESULTS Just over one half of the patients had a diagnosis of schizophrenia or schizoaffective disorder. One third of the sample carried the diagnosis of psychosis NOS (not otherwise specified). After careful review, five out of seven of these psychotic-like cases were assessed as non-psychotic. Patients with Psychosis NOS associated with moderate or severe ID had the worst outcome. CONCLUSION This clinical review provides important information about the identification, diagnosis and outcome of psychotic symptoms in youth with low verbal abilities.
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Wright SD, Russell P. Interventions for psychosis in adolescents. Hippokratia 2004. [DOI: 10.1002/14651858.cd004965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Steve D Wright
- Malham House 25 Hyde Terrace Leeds West Yorkshire UK LS2 9NL
| | - Paul Russell
- Christian Medical College; Department of Child & Adolescent Psychiatry; Vellore 632002 Tamil Nadu India
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