Schizophrenia childhood-onset

Sporn, A. L., Greenstein, D. K., Gogtay, N. et al. Progressive brain volume loss during adolescence in childhood-onset schizophrenia. Am. J. Psychiatry 160 2181-2189, 2003. 

Although childhood cases are rare (McKenna et ah, 1994), schizophrenia has been identified in children since its earliest descriptions. Despite this, the nosological status of schizophrenia in children was controversial for many years, and the Diagnostic and Statistical Manual of Mental Disorders, 2nd ed. (DSM-II) category childhood schizophrenia included other psychotic disorders in children as well as autistic disorder, limiting the usefulness of early studies. The landmark studies by Kolvin (1971), however, clearly differentiated schizophrenia with onset in childhood from pervasive developmental disorders. 

TABLE 15.1 Brain Magnetic Resonance Imaging Volumes for Patients with Childhood-Onset Schizophrenia (n = 46) and Controls (n = 82)... 

Genetic factors are important in the pathogenesis of schizophrenia (Karayiorgou and Gogos, 1997), and the notion that such factors may be more salient in very early onset-cases fueled two classic family studies of childhood-onset cases (Kallmann and Roth, 1956 Kelvin et al., 1971). 

TABLE 15.2 Schizophrenia Spectrum Disorders in Parents of Childhood-Onset Schizophrenia Patients, Parents of Adult-Onset Schizophrenia Patients, and Parents of Community Controls... 

AOS, adult-onset schizophrenia COS, childhood-onset schizophrenia. "Rates of all diagnoses were determined hierarchically, whereby a person could only receive one of the four schizophrenia spectrum diagnoses. COS parents > AOS parents > control parents (x = 30.3, df = 2, p < 0.001). Adapted from Nicolson et al. (2000b)... 

Blinded scoring of the birth records of 36 patients with COS and 35 sibling controls found no significant differences between the groups (Nicolson et ah, 1999c). Moreover, the rate of complications in the early-onset patients of the NIMH study was similar to that seen in adult-onset patients. These preliminary results, as well as the work of others (Frangou, 1999), suggest that, while obstetric complications may play a role in the development of schizophrenia in some patients, they are not more salient in childhood-onset cases. 

The role of other factors in the pathogenesis of schizophrenia, such as prenatal nutritional deprivation or prenatal maternal infections, have, to our knowledge, not been investigated in patients with childhood-onset schizophrenia. Given the rarity of this condition, such studies are unlikely. 

TABLE 15.3 Risk Factors for Schizophrenia in Patients with Childhood Onset of the Disorder... 

Bedwell, J.S., Keller, B., Smith, A.K., Hamburger, S., Kumra, S., and Rapoport, J.L. (1999) Childhood-onset schizophrenia why does post-psychotic full-scale IQ decline Am J Psychiatry 156 1996-1997. 

Bertolino, A., Kumra, S., Callicott, J.H., Mattay, V.S., Lestz, R.M., Jacobsen, L., Barnett, I.S., Duyn, J.H., Frank, J.A., Rapoport, J.L., and Weinberger, D.R. (1998) Common pattern of cortical pathology in childhood-onset and adult-onset schizophrenia as identified by proton magnetic resonance spectroscopic imaging. Am J Psychiatry 155 1376-1383. 

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