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Schneider K, Leinweber K, Jamalabadi H, Teutenberg L, Brosch K, Pfarr JK, Thomas-Odenthal F, Usemann P, Wroblewski A, Straube B, Alexander N, Nenadić I, Jansen A, Krug A, Dannlowski U, Kircher T, Nagels A, Stein F. Syntactic complexity and diversity of spontaneous speech production in schizophrenia spectrum and major depressive disorders. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:35. [PMID: 37248240 DOI: 10.1038/s41537-023-00359-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/25/2023] [Indexed: 05/31/2023]
Abstract
Syntax, the grammatical structure of sentences, is a fundamental aspect of language. It remains debated whether reduced syntactic complexity is unique to schizophrenia spectrum disorder (SSD) or whether it is also present in major depressive disorder (MDD). Furthermore, the association of syntax (including syntactic complexity and diversity) with language-related neuropsychology and psychopathological symptoms across disorders remains unclear. Thirty-four SSD patients and thirty-eight MDD patients diagnosed according to DSM-IV-TR as well as forty healthy controls (HC) were included and tasked with describing four pictures from the Thematic Apperception Test. We analyzed the produced speech regarding its syntax delineating measures for syntactic complexity (the total number of main clauses embedding subordinate clauses) and diversity (number of different types of complex sentences). We performed cluster analysis to identify clusters based on syntax and investigated associations of syntactic, to language-related neuropsychological (verbal fluency and verbal episodic memory), and psychopathological measures (positive and negative formal thought disorder) using network analyses. Syntax in SSD was significantly reduced in comparison to MDD and HC, whereas the comparison of HC and MDD revealed no significant differences. No associations were present between speech measures and current medication, duration and severity of illness, age or sex; the single association accounted for was education. A cluster analysis resulted in four clusters with different degrees of syntax across diagnoses. Subjects with less syntax exhibited pronounced positive and negative symptoms and displayed poorer performance in executive functioning, global functioning, and verbal episodic memory. All cluster-based networks indicated varying degrees of domain-specific and cross-domain connections. Measures of syntactic complexity were closely related while syntactic diversity appeared to be a separate node outside of the syntactic network. Cross-domain associations were more salient in more complex syntactic production.
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Affiliation(s)
- Katharina Schneider
- Department of English and Linguistics, General Linguistics, University of Mainz, Mainz, Germany.
| | - Katrin Leinweber
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Hamidreza Jamalabadi
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Lea Teutenberg
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Julia-Katharina Pfarr
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Florian Thomas-Odenthal
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Paula Usemann
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Adrian Wroblewski
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Nina Alexander
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Axel Krug
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Arne Nagels
- Department of English and Linguistics, General Linguistics, University of Mainz, Mainz, Germany
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
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Comparative Efficacy and Tolerability of Antipsychotics for Juvenile Psychotic Disorders: A Systematic Review and Network Meta-Analysis. J Clin Psychopharmacol 2022; 42:198-208. [PMID: 35020712 DOI: 10.1097/jcp.0000000000001506] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Psychotic disorders produce important morbidity and disability in children and adolescents. There have been few relevant treatment trials, encouraging assessment of research aimed at testing efficacy and safety of antipsychotics for juveniles. We aimed to compare the short- and long-term efficacy and safety of antipsychotics to treat psychotic disorders among children and adolescents. METHODS Four major bibliographic databases (PubMed, MEDLINE, PsycINFO, and EMBASE) were searched for clinical trials of antipsychotics in children or adolescents, from database inception to May 2021. We searched for clinical trials comparing antipsychotics with control conditions for juvenile psychosis based on blinded review by 2 independent investigators (C.S.Y. and M.L.). We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses and applied the Cochrane risk-of-bias tool to appraise study quality. One reviewer (A.B.) performed data abstraction which was confirmed by 2 independent, blinded reviewers (C.S.Y. and M.L.). Primary outcomes were scores rating psychosis symptoms and dichotomized retention in treatment protocols versus dropouts because of adverse events. Effect sizes were pooled using frequentist random-effects network meta-analysis modeling to generate summary rate ratios (RRs) and Cohen d standardized mean differences. RESULTS Systematic searching generated 1330 unique records. Of these, short-term (n = 15, for 6 [3-12] weeks) and long-term (n = 10, for 12 [6-60] months) treatment trials involved 2208 (39.2% females; median age, 15.3 years), and 1366 subjects (35.0% females; median age, 15.6 years), respectively. Short-term reduction of psychosis scores ranked clozapine (d = -1.35; 95% confidence interval [CI], -1.97 to -0.73]), molindone (-1.22; 95% CI, -1.68 to -0.75), olanzapine (-1.12; 95% CI, -1.44 to -0.81), and risperidone (-0.93; 95% CI, -1.22 to -0.63) as the most effective agents. In longer-term treatment, only lurasidone was effective. Clozapine (RR, 12.8) and haloperidol (RR, 5.15) led to more all-cause and adverse event-related dropouts. There were few trials/drug (1 each for aripiprazole, asenapine, lurasidone, molindone, paliperidone, and ziprasidone, short term; aripiprazole, clozapine, haloperidol, lurasidone, and molindone, long-term). Heterogeneity and inconsistency were high, especially in long-term trials, without evidence of publication bias. CONCLUSIONS Some antipsychotics were effective and tolerated short term, but longer-term evidence was very limited. The overall paucity of trials and of adequate controls indicates that more well-designed randomized controlled trials are required for adequate assessment of antipsychotic drug treatment for juveniles. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021232937.
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3
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Mavroudis I, Petrides F, Kazis D, Chatzikonstantinou S, Karantali E, Ciobica A, Iordache AC, Dobrin R, Trus C, Njau S, Costa V, Baloyannis S. Morphological alterations of the pyramidal and stellate cells of the visual cortex in schizophrenia. Exp Ther Med 2021; 22:669. [PMID: 33986834 PMCID: PMC8111868 DOI: 10.3892/etm.2021.10101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/19/2021] [Indexed: 11/05/2022] Open
Abstract
Schizophrenia is a severe brain disorder characterized by certain types of delusion, hallucination and thought disorder. Studies have revealed impaired synaptic plasticity and reduced gamma-aminobutyric acid levels of the visual cortex in patients with schizophrenia. While previous work established a critical role for interneurons and cortical connectivity in the generation of hallucinations, the present study set out to examine the morphology of pyramidal cells and interneurons from layers 3 and 4 in the primary visual cortex from schizophrenic brains and to identify any dendritic and spinal alterations in comparison to normal control brains. The morphological and morphometric changes of the pyramidal cells and the interneurons of the visual cortices of 10 brains obtained from patients with schizophrenia, in comparison to 10 age-matched controls, were studied using the Golgi method and 3D neuronal reconstruction techniques. Analysis using the Golgi impregnation technique revealed a significant loss of distal dendritic segments, tortuous branches and varicosities and an overall restriction of the dendritic field in the brains of schizophrenic patients in both pyramidal cells and in aspiny interneurons. The present results may explain certain clinical phenomena associated with the visual cortex usually encountered in schizophrenia.
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Affiliation(s)
- Ioannis Mavroudis
- Laboratory of Neuropathology and Electron Microscopy First Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki 54634, Greece.,Department of Neurology, Leeds Teaching Hospitals, Leeds LS1 3EX, UK.,Institute For Research Of Alzheimer's Disease, Other Neurodegenerative Diseases And Normal Aging, Heraklion Langada 57200, Greece
| | - Foivos Petrides
- Laboratory of Neuropathology and Electron Microscopy First Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki 54634, Greece.,Third Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Dimitrios Kazis
- Third Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | | | - Eleni Karantali
- Third Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University, Iasi 700506, Romania.,Academy of Romanian Scientists, Bucuresti 050094, Romania.,Center of Biomedical Research, Romanian Academy, Iasi 700506, Romania
| | - Alin-Constantin Iordache
- Faculty of Medicine, 'Grigore T. Popa', University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Romeo Dobrin
- Faculty of Medicine, 'Grigore T. Popa', University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Constantin Trus
- Department of Morphological and Functional Sciences, Faculty of Medicine, Dunarea de Jos University, Galati 050094, Romania
| | - Samuel Njau
- Department of Forensic Medicine and Toxicology, Aristotle University of Thessaloniki, Thessaloniki 54634, Greece
| | - Vasiliki Costa
- Laboratory of Neuropathology and Electron Microscopy First Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki 54634, Greece.,Institute For Research Of Alzheimer's Disease, Other Neurodegenerative Diseases And Normal Aging, Heraklion Langada 57200, Greece
| | - Stavros Baloyannis
- Laboratory of Neuropathology and Electron Microscopy First Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki 54634, Greece.,Institute For Research Of Alzheimer's Disease, Other Neurodegenerative Diseases And Normal Aging, Heraklion Langada 57200, Greece
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4
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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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5
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Kobza AO, Alenezi S. Case Report of Childhood-Onset Psychosis in a Patient with a Known WNT10A Mutation. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2019; 28:147-150. [PMID: 31798653 PMCID: PMC6863571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 09/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To report on a patient with childhood-onset psychosis at age 12 with a known WNT10A mutation. METHODS Case report. RESULTS The patient is a 12-year-old male who presented with an acute onset of psychosis in the context of a known WNT10A mutation. CONCLUSION WNT genes have only been previously linked to schizophrenia on a theoretical basis. To our knowledge, this is the first case report of an association between a childhood-onset psychosis and a WNT10A mutation. We conclude that there is a possibility that WNT10A may be one of the many genes contributing to the development of childhood-onset schizophrenia.
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Affiliation(s)
- Alexandra O Kobza
- Department of Child and Adolescent Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Shuliweeh Alenezi
- Department of Child and Adolescent Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Ontario
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
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6
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Hoffman GE, Hartley BJ, Flaherty E, Ladran I, Gochman P, Ruderfer DM, Stahl EA, Rapoport J, Sklar P, Brennand KJ. Transcriptional signatures of schizophrenia in hiPSC-derived NPCs and neurons are concordant with post-mortem adult brains. Nat Commun 2017; 8:2225. [PMID: 29263384 PMCID: PMC5738408 DOI: 10.1038/s41467-017-02330-5] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/20/2017] [Indexed: 12/20/2022] Open
Abstract
The power of human induced pluripotent stem cell (hiPSC)-based studies to resolve the smaller effects of common variants within the size of cohorts that can be realistically assembled remains uncertain. We identified and accounted for a variety of technical and biological sources of variation in a large case/control schizophrenia (SZ) hiPSC-derived cohort of neural progenitor cells and neurons. Reducing the stochastic effects of the differentiation process by correcting for cell type composition boosted the SZ signal and increased the concordance with post-mortem data sets. We predict a growing convergence between hiPSC and post-mortem studies as both approaches expand to larger cohort sizes. For studies of complex genetic disorders, to maximize the power of hiPSC cohorts currently feasible, in most cases and whenever possible, we recommend expanding the number of individuals even at the expense of the number of replicate hiPSC clones.
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Affiliation(s)
- Gabriel E Hoffman
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Brigham J Hartley
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Erin Flaherty
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ian Ladran
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Peter Gochman
- Childhood Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Douglas M Ruderfer
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Division of Genetic Medicine, Departments of Medicine, Psychiatry and Biomedical Informatics, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Eli A Stahl
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Judith Rapoport
- Childhood Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Pamela Sklar
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Kristen J Brennand
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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The Clinical Presentation of Childhood-Onset Schizophrenia: A Literature Review. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1177/008124630603600206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This literature review explores the research on the clinical presentation of childhood-onset schizophrenia (COS) that was conducted in the period 1994–2004. A literature search was done using Internet search engines and psychological databases to collect English-language journal articles from 1994 onwards. Research indicates that COS is a stable diagnosis. Generally, there is a clear history of premorbid abnormalities, an insidious onset and a deteriorating course. For the majority of cases there seems to be a poor outcome. Despite the limitations in the research conducted thus far, findings provide important insights into COS and several possibilities for future research.
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Memarzia J, Tracy D, Giaroli G. The use of antipsychotics in preschoolers: a veto or a sensible last option? J Psychopharmacol 2014; 28:303-19. [PMID: 24451556 DOI: 10.1177/0269881113519506] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Recent reports have illustrated a dramatic rise in the use of antipsychotics in preschool children, medications originally designed and licensed for the treatment of adult psychotic disorders. Within this context, the current usage and the associated diagnoses are reviewed and compared with official guidelines and licensing for such use, highlighting a controversial challenge for clinicians. A review of the evidence base of the relative efficacy of such medications for a range of disorders is given. Associated safety and side effects are discussed, with compelling evidence for increased adverse events associated with use of antipsychotics in preschoolers, and neurodevelopmental hypotheses are used to guide predictions of long-term risk. An apparent gap in the literature and evidence base supporting such use and elucidating the risks and benefits leaves a challenge for clinicians and researchers and hinders the development of appropriate guidelines. Pragmatism in clinical practice, mindful of the limited evidence base that does exist and the propensity for harm, is necessary; far more research is required in this important area.
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Affiliation(s)
- Jessica Memarzia
- 1Department of Psychosis Studies, Institute of Psychiatry, King's College London, UK
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9
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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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10
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Payá B, Rodríguez-Sánchez JM, Otero S, Muñoz P, Castro-Fornieles J, Parellada M, Gonzalez-Pinto A, Soutullo C, Baeza I, Rapado-Castro M, Sáenz-Herrero M, Moreno D, Arango C. Premorbid impairments in early-onset psychosis: differences between patients with schizophrenia and bipolar disorder. Schizophr Res 2013; 146:103-10. [PMID: 23465966 DOI: 10.1016/j.schres.2013.01.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 01/08/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Despite the large body of research on premorbid impairments in schizophrenia, studies comparing different early-onset psychoses are scarce. AIMS To examine premorbid impairments in first episodes of early-onset bipolar and schizophrenia disorders. METHOD We compared premorbid adjustment and other premorbid variables such as IQ and developmental abnormalities in a cohort of children and adolescents (N=69) with bipolar disorder (BP) or schizophrenia (SZ) experiencing their first psychotic episode and in a healthy control group (N=91). RESULTS Schizophrenia patients showed more social impairment in childhood than bipolar patients (p<0.05) and healthy controls (p<0.001) and had higher rates of developmental abnormalities (p<0.05) than healthy controls. Between childhood and early adolescence, schizophrenia and bipolar patients showed a greater decline in academic adjustment than healthy controls, more specifically in adaptation to school (p<0.01). CONCLUSIONS Early-onset schizophrenia patients show more early social impairment than early-onset bipolar patients. Intellectual premorbid abnormalities are less specific and probably more linked to early-onset psychosis.
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Affiliation(s)
- Beatriz Payá
- Child and Adolescent Psychiatry and Psychology Unit, Hospital Universitario Marques de Valdecilla, Santander, Spain.
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11
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Weisinger B, Greenstein D, Mattai A, Clasen L, Lalonde F, Feldman S, Miller R, Tossell JW, Vyas NS, Stidd R, David C, Gogtay N. Lack of gender influence on cortical and subcortical gray matter development in childhood-onset schizophrenia. Schizophr Bull 2013; 39:52-8. [PMID: 21613381 PMCID: PMC3523910 DOI: 10.1093/schbul/sbr049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Progressive cortical gray matter (GM) abnormalities are an established feature of schizophrenia and are more pronounced in rare, severe, and treatment refractory childhood-onset schizophrenia (COS) cases. The effect of sex on brain development in schizophrenia is poorly understood and studies to date have produced inconsistent results. METHODS Using the largest to date longitudinal sample of COS cases (n = 104, scans = 249, Male/Female [M/F] = 57/47), we compared COS sex differences with sex differences in a sample of matched typically developing children (n = 104, scans = 244, M/F = 57/47), to determine whether or not sex had differential effects on cortical and subcortical brain development in COS. RESULTS Our results showed no significant differential sex effects in COS for either GM cortical thickness or subcortical volume development (sex × diagnosis × age interaction; false discovery rate q = 0.05). CONCLUSION Sex appears to play a similar role in cortical and subcortical GM development in COS as it does in normally developing children.
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Affiliation(s)
- Brian Weisinger
- Child Psychiatry Branch, National Institutes of Mental Health, 10/3N202, 10 Center Drive, Bethesda, MD, 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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Dueck A, Thome J, Haessler F. The role of sleep problems and circadian clock genes in childhood psychiatric disorders. J Neural Transm (Vienna) 2012; 119:1097-104. [PMID: 22669264 DOI: 10.1007/s00702-012-0834-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 05/20/2012] [Indexed: 11/25/2022]
Abstract
CLOCK gene research and the analysis of circadian rhythmicity on the behavioural, cellular and molecular level are increasingly contributing to accumulate clinically relevant knowledge in the fields of neuroscience, psychopharmacology and adult psychiatry. However, the role of circadian phenomena, including sleep alterations in mental disorders during childhood and adolescence remains largely enigmatic. Fortunately, recent publications have addressed this problem and there is now some evidence available highlighting the relevance of CLOCK genes in conditions, such as ADHD, mood disorders, schizophrenia and anxiety disorders.
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Affiliation(s)
- Alexander Dueck
- Cinic of Child and Adolescence Psychiatry, Neurology, Psychosomatics and Psychotherapy, University of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany.
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Ross RG, Stevens KE, Proctor WR, Leonard S, Kisley MA, Hunter SK, Freedman R, Adams CE. Research review: Cholinergic mechanisms, early brain development, and risk for schizophrenia. J Child Psychol Psychiatry 2010; 51:535-49. [PMID: 19925602 PMCID: PMC2862788 DOI: 10.1111/j.1469-7610.2009.02187.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The onset of diagnostic symptomology for neuropsychiatric diseases is often the end result of a decades-long process of aberrant brain development. Identification of novel treatment strategies aimed at normalizing early brain development and preventing mental illness should be a major therapeutic goal. However, there are few models for how this goal might be achieved. This review uses the development of a psychophysiological correlate of attentional deficits in schizophrenia to propose a developmental model with translational primary prevention implications. Review of genetic and neurobiological studies suggests that an early interaction between alpha7 nicotinic receptor density and choline availability may contribute to the development of schizophrenia-associated attentional deficits. Therapeutic implications, including perinatal dietary choline supplementation, are discussed.
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Affiliation(s)
- Randal G Ross
- Department of Psychiatry, University of Colorado Denver, Aurora, CO, USA
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Mattai A, Chavez A, Greenstein D, Clasen L, Bakalar J, Stidd R, Rapoport J, Gogtay N. Effects of clozapine and olanzapine on cortical thickness in childhood-onset schizophrenia. Schizophr Res 2010; 116:44-8. [PMID: 19913390 PMCID: PMC2795130 DOI: 10.1016/j.schres.2009.10.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 10/19/2009] [Accepted: 10/19/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about the effects of antipsychotic medications on gray matter (GM) in schizophrenia. Although clozapine remains the most effective antipsychotic medication in treatment-refractory cases, it is unknown whether it has a differential effect on GM development. METHODS In an exploratory analysis, we used automated cortical thickness measurements and prospectively scanned childhood-onset schizophrenia (COS) patients who were maintained on one medication. Two atypical antipsychotic medications, clozapine (n=12, 37 scans) and olanzapine (n=12, 33 scans) were compared with respect to effects on cortical development, in contrast to GM trajectories of matched controls. RESULTS There were no significant differences in the trajectories of cortical thickness between the two treatment groups with the exception of a small circumscribed area in the right prefrontal cortex, where the olanzapine group showed thicker cortex. As expected, both groups showed thinner GM compared to matched controls. CONCLUSIONS Although these analyses do not rule out effects of antipsychotic medications on GM development in schizophrenia, they show no differential effect between clozapine and olanzapine on GM trajectory.
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Affiliation(s)
- Anand Mattai
- Child Psychiatry Branch, NIMH, NIH, Bethesda, MD, 20892-1600, United States.
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Fraguas D, de Castro MJ, Medina O, Parellada M, Moreno D, Graell M, Merchán-Naranjo J, Arango C. Does diagnostic classification of early-onset psychosis change over follow-up? Child Psychiatry Hum Dev 2008; 39:137-45. [PMID: 17665305 DOI: 10.1007/s10578-007-0076-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 07/16/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the diagnostic stability and the functional outcome of patients with early-onset psychosis (EOP) over a 2-year follow-up period. METHODS A total of 24 patients (18 males (75%) and 6 females (25%), mean age +/- SD: 15.7 +/- 1.6 years) with a first episode of EOP formed the sample. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Social disability was measured with the Global Assessment of Functioning (GAF) disability scale. Diagnosis was assessed using the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL), according to DSM-IV criteria. All diagnoses were re-assessed after 1 year and 2 years. RESULTS Schizophrenia had the highest prospective consistency (100% predictive value), while diagnostic stability was moderate for bipolar disorder (71.4%), and low for schizoaffective disorder (50%), schizophreniform and brief psychosis (50%), and psychosis not otherwise specified (NOS) (16.7%). The agreement between the baseline diagnoses and the 1-year follow-up diagnoses was 54.2%, whereas between the 1-year follow-up and the 2-year follow-up, it rose to 95.7%. Regardless of diagnosis, baseline negative symptoms were the only significant predictor of level of functioning at the 2-year follow-up (p = 0.010). CONCLUSION Our results highlight the primacy of the first-year follow-up diagnosis in predicting diagnostic stability of EOP.
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Affiliation(s)
- David Fraguas
- Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Ibiza 43, CP 28009, Madrid, Spain.
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Abstract
Childhood-onset schizophrenia (COS; defined as onset by age 12 years) is rare, difficult to diagnose, and represents a severe and chronic phenotype of the adult-onset illness. A study of childhood-onset psychoses has been ongoing at the National Institute of Mental Health (NIMH) since 1990, where children with COS and severe atypical psychoses (provisionally labeled "multidimensionally impaired" or MDI by the NIMH team) are studied prospectively along with all first-degree relatives. COS subjects have robust cortical gray matter (GM) loss during adolescence, which appears to be an exaggeration of the normal cortical GM developmental pattern and eventually mimics the pattern seen in adult-onset cases as the children become young adults. These cortical GM changes in COS are diagnostically specific and seemingly unrelated to the effects of medications. Furthermore, the cortical GM loss is also shared by healthy full siblings of COS probands suggesting a genetic influence on the abnormal brain development.
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Affiliation(s)
- Nitin Gogtay
- Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
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18
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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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Habel U, Krasenbrink I, Bowi U, Ott G, Schneider F. A special role of negative emotion in children and adolescents with schizophrenia and other psychoses. Psychiatry Res 2006; 145:9-19. [PMID: 17069893 DOI: 10.1016/j.psychres.2005.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Revised: 08/14/2005] [Accepted: 11/03/2005] [Indexed: 12/14/2022]
Abstract
Emotional impairments are apparent at an early stage in schizophrenia. While emotion processing has been studied intensively in adult patients, investigations focusing on children and adolescents with psychoses are rare. Emotion probes for mood induction and emotion discrimination that have been standardized in healthy subjects and applied to adult schizophrenia patients were evaluated in young patients (11-20 years). Twenty children and adolescents with schizophrenia and other psychotic disorders as well as twenty healthy volunteers matched for age, gender and parental education were examined. Results reveal successful mood induction in both patients and healthy volunteers, but with more negative affect prominent in patients. While a reduced ability to discriminate negative emotional faces emerged in patients than in controls, this difference failed to reach statistical significance. The similarities between test results of children and adolescents compared with those of adults demonstrate that both tests proved to be useful when applied to younger ages. Negative affect seems to be differentially affected, a finding that which may be already evident in the early course of schizophrenia.
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Affiliation(s)
- Ute Habel
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany.
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20
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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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Ross RG, Novins D, Farley GK, Adler LE. A 1-year open-label trial of olanzapine in school-age children with schizophrenia. J Child Adolesc Psychopharmacol 2003; 13:301-9. [PMID: 14642018 DOI: 10.1089/104454603322572633] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the response of children with childhood-onset schizophrenia to a 1-year prospective, open-label trial of olanzapine. METHODS Twenty children (age range 6-15 years) with childhood-onset Diagnostic and Statistical Manual of Mental Disorders (fourth edition) schizophrenia participated. The treating clinician was free to vary or discontinue dosing and use additional medications. Symptoms were assessed by the Brief Psychiatric Rating Scale-Child version (BPRS-C), Scale for the Assessment of Positive Symptoms, and Scale for the Assessment of Negative Symptoms. Extrapyramidal symptoms, akathisia, temperature, and weight were monitored. RESULTS BPRS-C subscales of thought disturbance and psychomotor excitation, and the Scale for the Assessment of Positive Symptoms demonstrated significant decreases by 6 weeks of treatment; BPRS-C anxiety and the Scale for the Assessment of Negative Symptoms (SANS) showed significant improvement after 1 year of treatment. Seventy-four percent of subjects were considered treatment responders, with a greater than 20% reduction in total BPRS-C score and overall impairment of mild or better. Weight gain (body mass index) was above that expected for normal development in every child. No child developed neuroleptic-related dyskinesias. Seventy-four percent (n = 14) of patients completed this 1-year, open-label trial. Of the 5 subjects who discontinued, weight gain was noted as the reason for 4 subjects. CONCLUSIONS Olanzapine appears useful in the treatment of childhood-onset schizophrenia, although there may be a delayed onset of benefit for anxiety and negative symptoms. Weight gain is problematic, but the emergence of dyskinesias may be rare. Additional controlled trials are indicated.
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Affiliation(s)
- Randal G Ross
- Department of Psychiatry, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
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Read J, Ross CA. Psychological trauma and psychosis: another reason why people diagnosed schizophrenic must be offered psychological therapies. THE JOURNAL OF THE AMERICAN ACADEMY OF PSYCHOANALYSIS AND DYNAMIC PSYCHIATRY 2003; 31:247-68. [PMID: 12722898 DOI: 10.1521/jaap.31.1.247.21938] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article summarizes the research literature documenting the high prevalence of psychological trauma, including childhood sexual and physical abuse, among people diagnosed psychotic in general and schizophrenic in particular. A review of the relevant literature indicates that childhood trauma may in some cases be causally related to the development of psychotic symptomatology later in life, perhaps by contributing to the diathesis in the stress-diathesis equation. However it is argued that regardless of whether clinicians view the relationship as causal, contributory, co-morbid, or coincidental is irrelevant to the fact that this high prevalence dictates that all people diagnosed schizophrenic receive a proper trauma assessment and, where appropriate, be offered psychological treatments to address the sequelae of the trauma or abuse. Taken in conjunction with the proven effectiveness of various psychological and psychosocial treatments in ameliorating the symptomatology and improving the quality of life of people diagnosed schizophrenic, the need to address the trauma found in such high rates in this population requires a broadening, and not as some suggest a limitation, of the range of treatments offered. The authors identify and challenge ideologically, rather than empirically, driven assumptions about the etiology of schizophrenia, particularly the distorted but dominant version of the diathesis-stress model, which claims that the diathesis is predominantly or exclusively biogenetic in origin and therefore inaccurately places all psychosocial stressors and traumas exclusively on the stress side of the equation. It is this bias that inhibits many clinicians from taking trauma histories with people diagnosed schizophrenic and from offering appropriate treatment when trauma is disclosed. It is the same bias that leads some to argue for a reduction in the availability of psychological therapies for such people.
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Affiliation(s)
- John Read
- The University of Auckland, New Zealand
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Freedman R, Adams CE, Adler LE, Bickford PC, Gault J, Harris JG, Nagamoto HT, Olincy A, Ross RG, Stevens KE, Waldo M, Leonard S. Inhibitory neurophysiological deficit as a phenotype for genetic investigation of schizophrenia. AMERICAN JOURNAL OF MEDICAL GENETICS 2003; 97:58-64. [PMID: 10813805 DOI: 10.1002/(sici)1096-8628(200021)97:1<58::aid-ajmg8>3.0.co;2-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Many investigators have proposed that biological endophenotypes might facilitate the genetic analysis of schizophrenia. A deficit in the inhibition of the P50 evoked response to repeated auditory stimuli has been characterized as a neurobiological deficit in schizophrenia. This deficit is linked to a candidate gene locus, the locus of the alpha7-nicotinic cholinergic receptor subunit gene on chromosome 15q14. Supportive evidence has been found by other investigators, including: 1) linkage of schizophrenia to the same locus; 2) linkage of bipolar disorder to the locus; and 3) replication of the existence of this neurobiological deficit and its relation to broader neuropsychological deficits in schizophrenia. It is certain that there are many genetic factors in schizophrenia and bipolar disorder; what is needed is a complete and precise description of the contribution of each individual factor to the pathophysiology of these illnesses.
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Affiliation(s)
- R Freedman
- Psychiatry and Pharmacology, University of Colorado, CO 80262, USA.
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Schaeffer JL, Ross RG. Childhood-onset schizophrenia: premorbid and prodromal diagnostic and treatment histories. J Am Acad Child Adolesc Psychiatry 2002; 41:538-45. [PMID: 12014786 DOI: 10.1097/00004583-200205000-00011] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE There is increasing interest in the possible relationship between the early diagnosis and treatment of schizophrenia during adolescence and improved long-term outcome. This study reviews the premorbid and prodromal diagnostic and treatment histories for childhood-onset schizophrenia, to assess whether early identification and treatment is possible in this school-age group. METHOD Parents of 17 children with childhood-onset schizophrenia or schizoaffective disorder were questioned retrospectively regarding symptoms, exposure to mental health professionals, diagnoses, and treatments. RESULTS Initial presenting symptoms clustered around violent aggression and school problems. Age of first recognized psychotic symptoms ranged from 2 to 11 years, followed 2.0+/-2.0 years later by a diagnosis of schizophrenia. Prior to a schizophrenia diagnosis, these children were exposed to stimulants, antidepressants, lower-dose typical neuroleptics, mood stabilizers, alternative treatments, and individual and family therapy. CONCLUSION Early diagnosis of childhood-onset schizophrenia is met with caution in the psychological and medical community. These children received many diagnoses before schizophrenia or schizoaffective disorder was diagnosed. A diagnosis of schizophrenia or schizoaffective disorder and utilization of effective atypical neuroleptic treatment was delayed until evaluation by a child and adolescent psychiatrist. Obstacles to early identification and treatment are discussed.
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Affiliation(s)
- John L Schaeffer
- Department of Psychiatry, Denver Veterans Administration Medical Center, CO 80262, USA
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25
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Abstract
The diagnosis of bipolar mood disorder (BP) in preadolescents (pediatric mania) has generated considerable controversy in terms of its estimated prevalence and validity as a diagnostic category. The relative paucity of systematic studies and the current diagnostic confusion related to the disorder are often attributed to the apparent discontinuities in the childhood versus adult presentation of the illness, namely, irritability as the predominant "mood" of mania and a continuous course of symptoms. The goal of this article is to review the current literature and identify sources of confusion relating to pediatric mania by considering results to date within a larger context that include findings from studies on (1) BP illness in adults, (2) mood disorders across the lifespan, (3) the role of development in symptom expression, and (4) patterns of heritability in psychiatric disorders. Whereas much remains to be investigated in the validation of the diagnosis for children, integrating results across studies may provide a framework for understanding the differences in the presentation of severe mood disorders in children and adults.
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Affiliation(s)
- Jill Weckerly
- Child and Adolescent Services Research Center, San Diego, CA 92123, USA
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Read J, Perry BD, Moskowitz A, Connolly J. The contribution of early traumatic events to schizophrenia in some patients: a traumagenic neurodevelopmental model. Psychiatry 2001; 64:319-45. [PMID: 11822210 DOI: 10.1521/psyc.64.4.319.18602] [Citation(s) in RCA: 333] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current diathesis-stress model of schizophrenia proposes that a genetic deficit creates a predisposing vulnerability in the form of oversenstivity to stress. This model positions all psychosocial events on the stress side of the diathesis-stress equation. As an example of hypotheses that emerge when consideration is given to repositioning adverse life events as potential contributors to the diathesis, this article examines one possible explanation for the high prevalence of child abuse found in adults diagnosed schizophrenic. A traumagenic neurodevelopmental (TN) model of schizophrenia is presented, documenting the similarities between the effects of traumatic events on the developing brain and the biological abnormalities found in persons diagnosed with schizophrenia, including overreactivity of the hypothalamic-pituitary-adrenal (HPA) axis; dopamine, norepinephrine, and serotonin abnormalities; and structural changes to the brain such as hippocampal damage, cerebral atrophy, ventricular enlargement, and reversed cerebral asymmetry. The TN model offers potential explanations for other findings in schizophrenia research beyond oversensitivity to stress, including cognitive impairment, pathways to positive and negative symptoms, and the relationship between psychotic and dissociative symptomatology. It is recommended that clinicians and researchers explore the presence of early adverse life events in adults with psychotic symptoms in order to ensure comprehensive formulations and appropriate treatment plans, and to further investigate the hypotheses generated by the TN model.
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Affiliation(s)
- J Read
- Psychology Department, University of Auckland, Private Bag 92019, Auckland 1, New Zealand.
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Sowell ER, Toga AW, Asarnow R. Brain abnormalities observed in childhood-onset schizophrenia: a review of the structural magnetic resonance imaging literature. MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS 2000; 6:180-5. [PMID: 10982495 DOI: 10.1002/1098-2779(2000)6:3<180::aid-mrdd5>3.0.co;2-i] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Childhood-onset schizophrenia (COS) is a rare, severe form of schizophrenia in which there are structural brain abnormalities that may be related to the psychotic symptomatology and neurocognitive deficits found in these patients. While there are numerous structural imaging studies of the adult-onset variant of schizophrenia (with many conflicting findings), relatively few brain imaging studies of COS have been conducted. This paper summarizes the extant literature of magnetic resonance imaging (MRI) studies of structural brain abnormalities in COS, and compares findings to similar studies of adult-onset patients. Volumetric MRI studies of COS patients have consistently shown evidence for increased ventricular volume, reduced cerebral gray matter, and increased caudate volume, consistent with findings from adult-onset studies. Other volumetric brain abnormalities are observed in COS patients, such as reduced total brain volume, but not consistently across all studies. Voxel-based morphometric analyses have revealed abnormalities in the shape and spatial location of structures in COS such as the corpus callosum, caudate, and thalamus that could not be observed in the more traditional volumetric assessments. Similar findings also are observed in adult-onset patients. Progressive degenerative changes, such as ventricular enlargement, appear to occur in COS only until young adulthood where there is an apparent asymptote with no further degenerative changes. This is consistent with the lack of progressive changes noted in most longitudinal studies of adult-onset schizophrenia.
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Affiliation(s)
- E R Sowell
- Department of Neurology, Laboratory of Neuro Imaging, University of California, Los Angeles, California 90095-1769, USA.
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Kumra S, Wiggs E, Bedwell J, Smith AK, Arling E, Albus K, Hamburger SD, McKenna K, Jacobsen LK, Rapoport JL, Asarnow RF. Neuropsychological deficits in pediatric patients with childhood-onset schizophrenia and psychotic disorder not otherwise specified. Schizophr Res 2000; 42:135-44. [PMID: 10742651 DOI: 10.1016/s0920-9964(99)00118-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Children with transient psychotic symptoms and serious emotional disturbances who do not meet current criteria for schizophrenia or other presently recognized diagnostic categories commonly present diagnostic and treatment problems. Clarifying the connections between children with narrowly defined schizophrenia and children with a more broadly defined phenotype (i.e., Psychotic Disorder Not Otherwise Specified, PD-NOS) has implications for understanding the pathophysiology of schizophrenia. In this study, the neuropsychological test performance of a subgroup of children with atypical psychosis was compared with that of patients with childhood-onset schizophrenia (COS). METHOD Cognitive function was assessed with neuropsychological test battery regimens in 51 neuroleptic-nonresponsive patients within the first 270 at NIMH testing (24 PD-NOS, 27 COS) were included in this analysis. Seventeen (39%) of 44 COS subjects were unavailable for this study as their IQ tested <70. The PD-NOS patients were younger than the COS patients at the time of testing (12.0+/-2.8 vs 14.4+/-1.8years, respectively, p<0.004). The test levels of these groups were compared with each other. RESULTS The neuropsychological test results for the PD-NOS and COS patients were 1-2standard deviations below normative data across a broad array of cognitive functions. There were no overall differences in the test levels for the six summary scales (F=2.82, df=1, 36, p=0.10) or in the profile shape (F=1.70, df=5, 180, p=0.14) between the PD-NOS and COS groups. For the COS patients, there was a significant difference between their mean full-scale WISC IQ (84.7+/-16.2) and their average standard scores for both the spelling (97.7+/-16.1, n=23, t=4.0, p=0.001) and reading decoding subtests (97.7+/-13.7, n=23, t=3.7, p=0.001) of the Kaufman Test of Educational Achievement. CONCLUSIONS Treatment-refractory PD-NOS and COS patients share a similar pattern of generalized cognitive deficits, including deficits in attention, learning and abstraction which are commonly observed in adult patients with schizophrenia. These data support a hypothesis that at least some of the PD-NOS cases belong within the schizophrenic spectrum, which is of importance for future genetic studies planned for this cohort.
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Affiliation(s)
- S Kumra
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD, USA
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Abstract
Childhood-onset schizophrenia (defined by an onset of psychosis by age 12) is a rare and severe form of the disorder that is clinically and neurobiologically continuous with the adult-onset disorder. There is growing evidence for more salient risk or etiologic factors, particularly familial, in this possibly more homogeneous patient population. For the 49 patients with very early onset schizophrenia studied to date at the National Institute of Mental Health, there were more severe premorbid neuro-developmental abnormalities, a higher rate of cytogenetic anomalies, and a seemingly higher rate of familial schizophrenia and spectrum disorders than later onset cases. There was no evidence for increased obstetric complications or environmental stress. These data, while preliminary, suggest that a very early age of onset of schizophrenia may be secondary to greater familial vulnerability. Consequently, genetic studies of these patients may be particularly informative and may provide important etiologic information.
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Affiliation(s)
- R Nicolson
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, Maryland 20892-1600, USA
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30
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Adler LE, Freedman R, Ross RG, Olincy A, Waldo MC. Elementary phenotypes in the neurobiological and genetic study of schizophrenia. Biol Psychiatry 1999; 46:8-18. [PMID: 10394470 DOI: 10.1016/s0006-3223(99)00085-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This review describes the strategy of using elementary phenotypes for neurobiological and genetic linkage studies of schizophrenia. The review concentrates on practical aspects of selecting the phenotype and then understanding the confounds in its measurement and interpretation. Examples from the authors' studies of deficits in P50 inhibition and smooth pursuit eye movement dysfunction are presented. These two phenotypes share considerable similarity in their neurobiology, including a similar response to nicotine. They also appear to co-segregate with the genetic risk for schizophrenia as autosomal co-dominant phenotypes. Although most schizophrenic patients inherit these abnormalities unilinealy, i.e., from one parent, apparent bilineal inheritance produces a more severe illness, observed clinically as childhood-onset schizophrenia. The initial study showing linkage of the P50 deficit to the chromosome 15q14 locus of the alpha 7-nicotinic acetylcholine receptor is an example of the potential usefulness of these phenotypes for combined genetic and neurobiological study of schizophrenia.
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Affiliation(s)
- L E Adler
- Department of Psychiatry, University of Colorado Health Sciences Center, Denver 80262, USA
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31
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Fernandez T, Yan WL, Hamburger S, Rapoport JL, Saunders AM, Schapiro M, Ginns EI, Sidransky E. Apolipoprotein E alleles in childhood-onset schizophrenia. ACTA ACUST UNITED AC 1999. [DOI: 10.1002/(sici)1096-8628(19990416)88:2<211::aid-ajmg20>3.0.co;2-m] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ross RG, Olincy A, Harris JG, Radant A, Hawkins M, Adler LE, Freedman R. Evidence for bilineal inheritance of physiological indicators of risk in childhood-onset schizophrenia. ACTA ACUST UNITED AC 1999. [DOI: 10.1002/(sici)1096-8628(19990416)88:2<188::aid-ajmg17>3.0.co;2-e] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sigurdsson E, Fombonne E, Sayal K, Checkley S. Neurodevelopmental antecedents of early-onset bipolar affective disorder. Br J Psychiatry 1999; 174:121-7. [PMID: 10211165 DOI: 10.1192/bjp.174.2.121] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Developmental impairments have been identified as a risk factor for early-onset schizophrenia. Affective symptoms are more common in children and adolescents with disordered neurodevelopmental than in healthy controls. AIMS To test the hypothesis that severe early-onset mood disorders are associated with developmental antecedents. METHOD We retrospectively identified 38 adolescent cases (15 female, 23 male; mean age 14.4 years, range 11-18) who met ICD-10 Research Diagnostic Criteria for a manic episode, bipolar affective disorder or psychotic depression, and 41 controls (25 female, 16 male, mean age 14.2 years, range 11-18) with depression but without psychotic features. RESULTS Cases were significantly more likely to have experienced delayed language, social or motor development (OR 5.5, 95% CI = 1.4-21.6, P = 0.01), in particular those who develop psychotic symptoms (OR 7.2, 95% CI = 1.8-28.6, P = 0.003). CONCLUSIONS Compared to early-onset unipolar depression, neurodevelopmental antecedents are over-represented in early-onset bipolar disorder. The validity of this finding was supported by contemporaneous IQ scores that are not subject to the same potential biases as case-note ratings.
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Sidransky E, Burgess C, Ikeuchi T, Lindblad K, Long RT, Philibert RA, Rapoport J, Schalling M, Tsuji S, Ginns EI. A triplet repeat on 17q accounts for most expansions detected by the repeat-expansion-detection technique. Am J Hum Genet 1998; 62:1548-51. [PMID: 9585604 PMCID: PMC1377155 DOI: 10.1086/301876] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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35
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Yan W, Jacobsen LK, Krasnewich DM, Guan XY, Lenane MC, Paul SP, Dalwadi HN, Zhang H, Long RT, Kumra S, Martin BM, Scambler PJ, Trent JM, Sidransky E, Ginns EI, Rapoport JL. Chromosome 22q11.2 interstitial deletions among childhood-onset schizophrenics and ?multidimensionally impaired? ACTA ACUST UNITED AC 1998. [DOI: 10.1002/(sici)1096-8628(19980207)81:1<41::aid-ajmg8>3.0.co;2-q] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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36
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Kumra S, Jacobsen LK, Lenane M, Zahn TP, Wiggs E, Alaghband-Rad J, Castellanos FX, Frazier JA, McKenna K, Gordon CT, Smith A, Hamburger S, Rapoport JL. "Multidimensionally impaired disorder": is it a variant of very early-onset schizophrenia? J Am Acad Child Adolesc Psychiatry 1998; 37:91-9. [PMID: 9444905 DOI: 10.1097/00004583-199801000-00022] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine the validity of diagnostic criteria for a subgroup of children with atypical psychosis (n = 19), designated here as "multidimensionally impaired." These children are characterized by poor attention and impulse control, psychotic symptoms, and poor affective control. METHOD Children and adolescents (n = 19) meeting our criteria for multidimensionally impaired syndrome with onset of psychotic symptoms at or before age 12 years were identified from a total of 150 in-person screenings for very early-onset schizophrenia between 1990 and 1996. We compared the premorbid adjustment, family history, follow-up status, and laboratory measures for a subgroup of these children with those of (1) a rigorously defined group of 29 children with DSM-III-R schizophrenia and (2) 19 children with attention-deficit hyperactivity disorder. RESULTS Patients with multidimensionally impaired syndrome and patients with very early-onset schizophrenia shared a similar pattern of early transient autistic features, postpsychotic cognitive decline, and an elevated risk of schizophrenic-spectrum disorders among their first-degree relatives. This pattern was not seen in the attention-deficit hyperactivity disorder group. In contrast to very early-onset schizophrenia, the multidimensionally impaired group had significantly poorer scores on the Freedom From Distractibility factor on the WISC-R, a less deviant pattern of autonomic reactivity, and no progression to schizophrenia. CONCLUSIONS The findings support the distinction of the multidimensionally impaired cases as separate from those with other psychiatric disorders, and there is somewhat greater evidence to suggest that this disorder belongs in the schizophrenia spectrum.
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Affiliation(s)
- S Kumra
- Child Psychiatry Branch, NIMH, Bethesda, MD 20892-1600, USA
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37
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Frazier JA, Alaghband-Rad J, Jacobsen L, Lenane MC, Hamburger S, Albus K, Smith A, McKenna K, Rapoport JL. Pubertal development and onset of psychosis in childhood onset schizophrenia. Psychiatry Res 1997; 70:1-7. [PMID: 9172272 DOI: 10.1016/s0165-1781(97)03062-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In this study, pubertal development was examined for a sample of children and adolescents with childhood onset schizophrenia (COS) defined as psychosis by age 12. Developmental and psychiatric histories were obtained for 28 adolescents (mean age 14.5 +/- 2.3 years) with severe, treatment refractory COS (14 males, 14 females). Age of onset of psychosis was also examined in relation to menarche and development of secondary sex characteristics. Girls had a trend towards developing secondary sex characteristics earlier than boys (P = 0.06), consistent with North American norms. Males (N = 14) and females (N = 14) had similar age of onset of psychosis. The age of development of secondary sex characteristics was associated with onset of psychosis for girls, but this finding was driven by one outlier. There was no significant correlation between development of psychosis and menarche. Neither male nor female probands differed significantly from their well siblings or from North American norms in their age of onset of pubertal development. There was no evidence of early onset of secondary sex characteristics for this sample. Finally, there was an absence of a clear relationship between onset of psychosis and indices of sexual development for these very early onset cases.
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Affiliation(s)
- J A Frazier
- Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA.
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Abstract
The aim of this study was to determine the frequency, demographic characteristics and course of children and adolescents admitted with a diagnosis of schizophrenia before the age of 18 years. The paper describes 312 patients from Denmark who were given a diagnosis of schizophrenia during the period between 1970 and 1993. Schizophrenia with a childhood onset was extremely rare. Only four children under the age of 13 years and 28 children under the age of 15 years had received such a diagnosis. The study showed that a number of adolescents who were diagnosed with schizophrenia at their first admission were not given the same diagnosis at later admissions in adulthood. The most common diagnoses in this group of apparently misdiagnosed cases were personality disorders, primarily borderline and antisocial personality disorder.
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Affiliation(s)
- P H Thomsen
- Psychiatric Hospital for Children and Adolescents, Department of Research, Hisskov, Denmark
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39
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Findling RL, Friedman L, Kenny JT, Swales TP, Cola DM, Schulz SC. Adolescent schizophrenia: a methodologic review of the current neuroimaging and neuropsychologic literature. J Autism Dev Disord 1995; 25:627-39. [PMID: 8720031 DOI: 10.1007/bf02178192] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This paper reviews all relevant articles that reported structural neuroimaging or neuropsychological data in adolescent patients with schizophrenia. These papers were subsequently examined from a methodological perspective. Few papers have been written that have examined whether adolescent schizophrenia is associated with structural neuroimaging abnormalities or cognitive dysfunction. In these studies, major methodologic issues exist. Therefore, at present, firm conclusions cannot be made regarding the presence or absence of neuropsychologic dysfunction or structural neuroimaging abnormalities in this population. Attention to certain methodologic issues may improve future studies of this topic.
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Affiliation(s)
- R L Findling
- Case Western Reserve University, Department of Psychiatry, Cleveland, Ohio 44106, USA
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40
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Campbell M, Cueva JE. Psychopharmacology in child and adolescent psychiatry: a review of the past seven years. Part II. J Am Acad Child Adolesc Psychiatry 1995; 34:1262-72. [PMID: 7592263 DOI: 10.1097/00004583-199510000-00011] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To present a critical overview of the selected literature published in the past 7 years on the efficacy and safety of psychoactive agents in conduct disorder, schizophrenia, separation anxiety disorder, selective mutism, obsessive-compulsive disorder, panic disorder, major depressive disorder, bipolar disorder, and sleep and eating disorders. METHOD Reports of double-blind and placebo-controlled trials and open studies were reviewed and selected studies presented. RESULTS Employment of larger samples of diagnostically homogeneous patients and a more sophisticated design and methodology led to progress in the treatment of most of these conditions. Data have been accumulated on dose range and safety of lithium in this age group, and there is supportive evidence that lithium is useful in reducing aggression. CONCLUSIONS For a rational treatment approach, further studies are needed, particularly in depression and conduct disorder; psychosocial-environment contributions and possible biological markers should be investigated in order to identify children who require psychopharmacological treatments and those who will respond to psychosocial interventions or the combination of both. Symptoms targeted to require pharmacotherapy and symptoms targeted to respond to psychosocial interventions have to be identified.
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Affiliation(s)
- M Campbell
- Department of Psychiatry, New York University Medical Center, NY 10016, USA
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41
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Alaghband-Rad J, McKenna K, Gordon CT, Albus KE, Hamburger SD, Rumsey JM, Frazier JA, Lenane MC, Rapoport JL. Childhood-onset schizophrenia: the severity of premorbid course. J Am Acad Child Adolesc Psychiatry 1995; 34:1273-83. [PMID: 7592264 DOI: 10.1097/00004583-199510000-00012] [Citation(s) in RCA: 131] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To review the premorbid histories of 23 children meeting DSM-III-R criteria for schizophrenia with onset before age 12 years and to compare these with childhood data of later-onset schizophrenics. METHOD Premorbid features up to 1 year before onset of first psychotic symptoms were rated from hospital and clinic records, clinical interviews, rating scales, and tests. RESULTS In keeping with previous studies, specific developmental disabilities and transient early symptoms of autism, particularly motor stereotypies, were common. Comparison with the childhood of later-onset schizophrenics showed greater delay in language development, and more premorbid speech and language disorders, learning disorders, and disruptive behavior disorders. (Sixty percent had received or were estimated to meet criteria for one or more clinical diagnoses.) CONCLUSIONS Childhood-onset schizophrenia may represent a more malignant form of the disorder, although selection and ascertainment bias cannot be ruled out. The presence of prepsychotic language difficulties focuses attention on the importance of early temporal and frontal lobe development; early transient motor stereotypies suggest developmental basal ganglia abnormalities and extend previous findings seen in the childhood of later-onset patients.
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Affiliation(s)
- J Alaghband-Rad
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892, USA
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42
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Abstract
Schizophrenia in children is an uncommon disorder with devastating effects. Study of the efficacy of treatment with neuroleptics in children with schizophrenia is only now beginning, and there are limited studies on the effectiveness of novel neuroleptics on the positive and negative symptoms of schizophrenia in children. Four patients with schizophrenia, aged 12 to 17 years, were treated with risperidone (4 to 5 mg/day), a 5-HT2/D2 receptor blocking agent, to determine its effectiveness. Three patients had substantial improvement in their negative symptoms without side effects.
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Affiliation(s)
- H Quintana
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, PA, USA
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Iida J, Iwasaka H, Hirao F, Hashino K, Matsumura K, Tahara K, Aoyama F, Sakiyama S, Tsujimoto H, Kawabata Y, Ikawa G. Clinical features of childhood-onset schizophrenia with obsessive-compulsive symptoms during the prodromal phase. Psychiatry Clin Neurosci 1995; 49:201-7. [PMID: 9179938 DOI: 10.1111/j.1440-1819.1995.tb01885.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Thirty-nine patients with schizophrenia, diagnosed according to DSM-III-R, who were under 15 years of age, were studied in two groups; 16 subjects with obsessive-compulsive symptoms during the prodromal phase, and 23 with no obsessive-compulsive disorders. The group with obsessive-compulsive symptoms during the prodromal phase was characterized by a higher ratio of males, higher incidences of perinatal and brain computed tomography (CT) abnormalities, fewer hereditary factors, longer duration of the prodromal phase, and a higher incidence of insidious onset and negative symptoms compared with the group without such prodromal symptoms. Schizophrenic patients with obsessive-compulsive symptoms during the prodromal phase were clinically distinct from those without, which suggests the possibility of subtype categorization.
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Affiliation(s)
- J Iida
- Department of Psychiatry, Nara Medical University, Japan
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