[Diagnostic and follow-up typological characteristics of early schizophrenia]

Abstract

Schizophrenic psychoses with early onset (< or = 10) are very rare; they occur in approx. 0.5-1% of the total number of patients. Long-term research with sufficiently long observation periods may be able to answer the question whether there is a nosological continuity between early-onset schizophrenia and schizophrenic psychoses in adults. We report on the results of a study on 13 patients with onset at the age of 10 years or earlier (7 girls, 6 boys) with an average duration of illness of 36.1 years (SD = 10.2 years). 3 patients had deceased in the meantime, one patient could not be reached by mail. 9 of the original 13 patients could be examined during the second follow-up by the same interviewer (on the average 27 years after the first follow-up). In 5 children the onset was acute (less than one week), in 8 children insidious (more than 4 weeks). Among the 5 patients with acute onset of childhood psychoses the positive PANSS-type (60%) predominated, in the 8 patients with at first barely perceptible beginning, the negative PANSS-type (45%) prevailed. In respect of the diagnostic division into subcategories, we found a remarkably large variability: At the beginning the disorganised type, at the first follow-up the paranoid, and at the second follow-up the catatonic and the disorganised type were diagnosed most frequently by 4 independent raters. The evaluation of the whole course shows that the incidence of the paranoid type was most frequent. Clear positive-productive psychotic symptoms occurred very early in our patients, i.e. already at the age of 7 years. On the whole, 77% of the patients showed positive symptoms from the beginning of psychotic breakdown; more than half of them had hallucinations from the beginning. This is contrary of the current opinion that childhood-onset schizophrenia begins predominantly with negative symptoms. However, at the beginning of insidious courses, negative symptoms prevail. The prognosis for the 8 insidious courses on the whole was unfavourable (only one full remission, one partial remission, the rest poor or very poor remissions). No connection between the total diagnosis (subtype) and the remission grade was seen.