Forty-two-years later: the outcome of childhood-onset schizophrenia

Abstract

This paper describes the long-term course of 76 patients who had been consecutively admitted to the Department of Child and Adolescent Psychiatry, Philipps University, between 1920 and 1961 with a suspected diagnosis of childhood-onset schizophrenia. By means of a consensus analysis of available data in accordance with ICD-10 criteria, the diagnosis of schizophrenia was confirmed in only 50% of the original sample (n = 38, childhood-onset schizophrenia group); whereas the rest of the sample were allotted other diagnoses (n = 38, non-schizophrenia group). A follow-up investigation was conducted, interviewing all available patients, if possible, or their first-degree relatives or doctors. In the childhood-onset schizophrenia group, age at onset (mean +/- S.D.) was 12.7 +/- 2.5 (range 5-14) years and age at follow-up was 55.0 +/- 4.8 (range 42-62) years. The outcome of this group was poor. According to the Global Assessment Scale (GAS), only 16% had a good (GAS score 71-100) and 24% had a moderate (GAS score 41-70) outcome. In the 16 childhood-onset schizophrenia patients who could be personally investigated at follow-up, 10 (62.5%) displayed severe or moderate depressive symptoms according to the BPRS depressive score. The death rate (including suicide) was significantly higher in the schizophrenia group (n = 15; 39.5%) than in the non-schizophrenia group (n = 7; 18.4%). A comparison of the life-time diagnoses of the total sample (n = 76) at follow-up with the ICD-10 diagnoses made retrospectively revealed a diagnostic stability in 69 (91%) and a change of diagnosis in 7 (9%) cases, among them 4 who were originally diagnosed as having childhood-onset schizophrenia.

Does Diagnostic Classification of Early-Onset Psychosis Change Over Follow-Up?

“…In this sense, as longitudinal observation of stability of diagnosis is essential to validate psychiatric diagnoses [6], the results of recent follow-up studies showing 80-100% diagnostic stability for early-onset schizophrenia and bipolar disorder [3][4][5][7][8][9] reinforce the nosological validity of these disorders, even when they are diagnosed in populations of children and adolescents.…”

“…Furthermore, a worse functional outcome in patients with EOP has been related to a diagnosis of schizophrenia [4,8,15], severity of negative [2,10] and positive symptoms [16], behavioral problems [2], premorbid functioning [3,10,17], childhood onset [11,17], and insidious onset [3]. An accurate diagnosis at baseline therefore seems important for predicting functional outcome at follow-up [18].…”

Early-Onset Schizophrenia1

“…The significance that young age at the onset of the disease has for its later course is revealed not just by comparisons across age groups in each of the relevant studies on this subject, but also by comparisons of patient groups across studies: the studies that included only patients who had developed schizophrenia before the age of 13 [20,21,22,23] all revealed a highly unfavorable course of disease in comparison to other studies of patients whose onset of disease was later.…”

Executive Impairment Predicts Schizophrenia Diagnosis and Treatment Status in Mid-Term Follow-Up of Early-Onset Psychosis

“…Newer data suggest, however, that the course of adolescent-onset schizophrenia may be similar to adult-onset schizophrenia which is not the case for childhood onset schizophrenia [31,32]. Moreover, in the whole group of SSD in the specific setting of the Early Psychosis Prevention and Intervention Centre, Amminger et al [10] observe after a mean follow-up of 7.4 years a better outcome in early-onset SSD than in adult-onset SSD.…”