Early-Onset Schizophrenia1

Abstract

The available study findings on the course and outcome of schizophrenia beginning in childhood or adolescence can be summarized as follows. (1) Schizophrenic psychoses that arise before the age of 13 have a very poor prognosis. The disease usually continues to progress in adolescence and adulthood. It can be diagnosed with the same criteria that are used for adults. (2) Patients whose disease is of acute onset, with productive schizophrenic manifestations such as hallucinations and delusions (positive manifestations), have a better prognosis than those whose disease begins insidiously and takes an unfavorable course, with depressive states and continually worsening impairment of cognitive function. (3) The patient’s premorbid personality plays a major role. Patients who were described as socially active, intelligent, and integrated children and adolescents before they became ill have a better prognosis than those who were intellectually impaired, timid, introverted and uncommunicative before they became ill. (4) The prognosis seems to be better for patients who have no family history of schizophrenia, those whose families cooperate well, and those whose condition improves rapidly during inpatient treatment. (5) The few available studies on the course and outcome of schizophrenia beginning in childhood and early adolescence confirm that they are much worse than in adult-onset schizophrenia. (6) A 42-year longitudinal study of patients with childhood-onset schizophrenia revealed their suicide rate to be higher than that of patients with adult-onset schizophrenia. No further longitudinal studies are available to confirm this finding.

Prognosis of schizophrenia in persons with and without a history of cannabis use

“…Also in another longitudinal study of patients with cannabis dependence in Stockholm County (Allebeck et al 1993), we found that schizophrenia patients with a history of cannabis use had a predominance of positive symptoms. In general, this would indicate a better prognosis (Remschmidt & Theisen, 2012), but the high number of readmissions and longer duration of hospital stay indicate poorer prognosis in these cases. We have not yet been able to analyse symptoms in more detail, but we plan to scrutinize medical records to assess clinical characteristics such as positive and negative symptoms in the two groups.…”

Diagnostic and treatment implications of psychosis secondary to treatable metabolic disorders in adults: a systematic review

“…It is also notable that data indicate a high degree of association of catatonia with organic disorders, especially if it occurs during childhood or adolescence [148]. An unusually high proportion of patients with organic disorders has been reported in large series of patients with early-onset schizophrenia, which suggests that an early-onset of schizophrenia-like symptoms is another indicator for possible organic origin of disease, especially if associated with progressive cognitive decline, which is a common feature in IEMs [149]. Finally, treatment resistance is frequently associated with IEMs [150], again suggesting its possible use as an indicator for possible organic disease.…”

Personality dimensions of schizophrenia patients compared to control subjects by gender and the relationship with illness severity

“…Personality is considered an important aspect of schizophrenia; it may influence symptom expression, patient insight, neurocognitive functioning, social functioning, and self-reported quality of life [1-3], and some premorbid personality traits may be related to an earlier presentation of disease [4,5]. Moreover, an overall prevalence rate of 39.5% for personality disorders has been reported among patients with psychotic disorders, although this prevalence rate does not differ from that for other severe mental illnesses [6].…”

“…Heterogeneity in personality traits may be related to clinical heterogeneity in schizophrenia and predict, for example, disease onset [4], suicide behavior [26-28] and hospital admission. To our knowledge, no studies have investigated the relationship between the number of psychiatric hospital admissions and personality traits in schizophrenia; however, hospital admission has been related to age of first hospital admission [29], stress management [30], neuroleptic treatment [31], gender, race [32], social support [33], and environmental conditions such as daily temperature range [34].…”