PSYCHOSIS OF INFANCY AND EARLY CHILDHOOD, AS MANIFESTED BY CHILDREN WITH ATYPICAL DEVELOPMENT

The ESSEN study of childhood-onset schizophrenia: selected results

INTRODUCTION

We present the results of a 42 year long-term follow-up of 44 patients (19 males, 25 females) with childhood-onset schizophrenia (COS, age at onset: 7-14 years) who could be traced for a second follow-up examination 27 years after the first follow-up.

METHOD

Data from interviews, clinical records, premorbid and social disability assessments were evaluated for statistical analyses. The symptomatology observed during the whole course of illness was rediagnosed by DSM-IV criteria.

RESULTS

The paranoid, catatonic, and schizoaffectives subtypes appeared most frequently. There have been no gender differences in age of first psychiatric symptoms (AFS), AFPS, and age of first hospitalization. Kaplan-Meier's survival-analysis carried out for AFPS with sex as the grouping factor revealed that the cumulative prevalence appears to be earlier in females (between 7 and 15 years) than in males (between 10 and 18 years). Of the 44 patients 50 % had a continuing severe course. Patients with onset before 12 years of age were characterized by a chronic/insidious onset, marked premorbid abnormalities, and by a poorer remission. Premorbid features of social withdrawal and reluctance indicated a risk for social disability within the later course.

CONCLUSION

COS, as a rare but severe variant of schizophrenia, frequently develops from premorbid social maladaptation to an insidious onset but is subsequently followed by a transition to a course and outcome not distinguishable from that of adult-onset schizophrenia.

Childhood psychosis in the preschool child

Six cases of childhood psychosis in children 3 to 5 years of age are summarized in order to alert clinicians to include this clinical entity in the differential diagnosis of children with major developmental difficulties. They represent children treated in a day, nonresidential treatment facility in a suburb of New York City. These cases suggest that we reexamine the prevalent interest in a bipolar distribution of childhood psychosis that focuses on children whose psychosis occurs under 3 and over 5 years of age. Children with psychosis occurring between 3 and 5 are currently described as essentially rare, and are characterized by a path of massive deterioration. Our cases indicate that we should be alert to the phenomenon of young children with psychosis appearing at the preschool age, and in whom the course of illness is in a more positive direction.

Course and prognosis of childhood schizophrenia

Follow-up data on 57 schizophrenic patients, including 25 boys and 32 girls between the ages of 7 and 13, is reported. Average length of follow-up was 15 years. Symptoms found in children under 10 and in prepubertal cases are described. Cases with acute, relapsing episodes occurred more often than chronic cases, but before age 11 acute cases were less frequent. Twenty percent of the patients recovered completely, 30% reached a relatively good social adjustment, and 50% had moderate or poor remission. Family incidence of psychiatric disorders had no influence on prognosis, nor did unfavorable family environment. Premorbid personality development was, however, found to be of prognostic value. Prodromal episodes occurred in 55% of the cases, and 65% of the patients were preoccupied by death. Additional follow-up findings are presented, and problems of diagnosis are discussed.

Age and type of onset as critical variables in early infantile autism

A retrospective study of 131 autistic children was made in which 2 groups, Natal and Acquired, were defined on the bases of age at onset and type of onset. Prenatal and perinatal variables were found to be significantly related to Natal onset, whereas in the Acquired group the significant variables were those occurring in early childhood, between years 1 and 3. Follow-up data on intellectual functioning and language development indicated a better prognosis for the Acquired group. An inability to cope with stress is postulated as an underlying feature in both instances, present from birth in the Natal group and occurring in the face of developmental stresses in the Acquired group.