A Review of Childhood-Onset Schizophrenia

Schizophrenia is a neurodevelopmental disorder with a multifactorial etiology. Pediatric schizophrenia consists of early-onset schizophrenia (onset prior to age 18 years) and childhood-onset schizophrenia (onset prior to age 13 years). Adolescence has been established as a critical period for neuronal pruning; hence, with earlier the onset of symptoms, there may be disruption in the normal process of neuronal development, causing impairments with memory, abstract thinking, and emotion regulation. Although the lifetime prevalence of schizophrenia is 1% in the general population, the incidence of pediatric schizophrenia is rare. Therefore, it is important to effectively evaluate the cause of any psychosis of a child or an adolescent. An accurate history and physical, including a detailed neurological examination, are vitally important, as are pertinent laboratory and imaging tests to rule out the many alternative differential diagnoses that also present with psychotic symptoms. The antipsychotics continue to be significantly more effective than placebo in treating pediatric schizophrenia in combination with psychotherapy, as evidenced by the recent Recover After an Initial Schizophrenia Episode (RAISE) study. However, further study is still needed to better understand causality, improve assessment, and develop a definitive treatment algorithm.