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Research update: childhood-onset schizophrenia: implications of clinical and neurobiological research
1Child Psychiatry Branch, NIMH, Bethesda, Maryland, MD 20892, USA.
Insights
Childhood-onset schizophrenia, a rare disorder, shows disrupted development before psychosis. Research suggests continuity with adult schizophrenia, with potential for progressive neurobiological changes.
Area of Science:
- Neuroscience
- Child Psychiatry
- Developmental Psychology
Background:
- Childhood-onset schizophrenia (COS) is a rare and severe form of schizophrenia.
- COS presents with disrupted cognitive, linguistic, and social development preceding psychotic symptoms.
- This developmental disruption offers insights into neurodevelopmental hypotheses of schizophrenia.
Purpose of the Study:
- To review studies on the phenomenology and neurobiology of COS since 1994.
- To examine diagnostic criteria and treatment efficacy in children with schizophrenia.
- To explore neurodevelopmental trajectories and etiological factors in COS.
Main Methods:
- Review of published research on childhood-onset schizophrenia since 1994.
- Analysis of diagnostic criteria (DSM-III, -IIIR, -IV) for COS.
- Evaluation of treatment outcomes with atypical neuroleptics, specifically clozapine.
- Synthesis of findings from neuropsychological and neurobiological studies.
- Examination of longitudinal data regarding cognitive function and brain changes.
Main Results:
- Children can be diagnosed with schizophrenia using standard DSM criteria.
- Clozapine is an effective treatment for medication-refractory childhood-onset schizophrenia.
- Neuropsychological and neurobiological findings suggest continuity with adult-onset schizophrenia, but with more severe premorbid impairment.
- Longitudinal studies indicate potential progressive ventricular enlargement and intellectual deterioration in COS.
- Onset appears insidious, suggesting a continuous or multi-event pathological process.
Conclusions:
- Childhood-onset schizophrenia is diagnosable with current criteria and treatable with clozapine.
- COS shares neurobiological similarities with adult-onset schizophrenia but exhibits greater premorbid deficits.
- Preliminary longitudinal data suggest a progressive neurodevelopmental pathology in COS, distinct from a single static event.
- Further research is needed to confirm progressive changes and elucidate the continuous or multi-event nature of COS pathology.
Abstract:
Childhood-onset schizophrenia is a rare, clinically severe form of schizophrenia, which is associated with disrupted cognitive, linguistic, and social development well before the appearance of frank psychotic symptoms. This disruption of multiple developmental domains signals the important opportunity these patients present for examining neurodevelopmental and other etiologic hypotheses of schizophrenia. The present research update reviews studies of the phenomenology and neurobiology of childhood-onset schizophrenia conducted since 1994. Findings from these studies indicate that children can be diagnosed with schizophrenia using unmodified DSM-III, -IIIR, and -IV criteria, and that the atypical neuroleptic clozapine is an effective medication for this treatment refractory group. Neuropsychologic and neurobiologic studies generally support continuity with adult-onset schizophrenia, with evidence of more severe premorbid impairment. Longitudinal studies show preliminary evidence of progressive ventricular enlargement and more prolonged deterioration in intellectual function than is seen in the adult-onset disorder. If replicated, these observations, together with the insidious onset of this disorder, would suggest that the pathologic underpinning of childhood-onset schizophrenia is not a single static lesion or event but may be a continuous or multi-event process.
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