National record-linkage study of hospital admissions for schizophrenia in childhood and adolescence in England

Abstract

Background There is a lack of information on changes in hospital admission rates for childhood-onset schizophrenia (COS), or on patient characteristics, to inform clinical research and health service provision. Aims To report age- and sex-specific incidence rates of hospital admissions and day patient care for schizophrenia (ICD-10 F20) and non-affective psychosis (ICD-10 F20-29), by year of occurrence and age, in childhood and adolescence. Methods Population-based study using person-linked data for England (available 2001–2016); time-periods in single years and 4-year groups. Results Hospitalised incidence for schizophrenia increased with increasing age, from 0.03 (95% confidence interval (CI) 0.02–0.05) and 0.01 (0–0.01) per 100,000 in, respectively, males and females aged 5–12 years, to 3.67 (3.44–3.91) in males and 1.58 (1.43–1.75) in females aged 13–17 years. There was no gender difference in hospitalised incidence rates in children aged 5–12, but in 13–17 years old, there was a male excess. Rates for schizophrenia were stable over time in 5–12 years old. In ages 13–17, rates for schizophrenia decreased between 2001–2004 and 2013–2016 in males, from 6.65 (6.04–7.31) down to 1.40 (1.13–1.73), and in females from 2.42 (2.05–2.83) to 1.18 (0.92–1.48). The hospitalisation rates for schizophrenia and non-affective psychosis, combined, in 13–17 years old decreased in males from 14.20 (13.30–15.14) in 2001–2004 to 10.77 (9.97–11.60) in 2013–2016, but increased in females from 7.49 (6.83–8.20) to 10.16 (9.38–11.00). Conclusions The study confirms that childhood-onset schizophrenia is extremely rare, with only 32 cases identified over a 15-year period in the whole of England. The incidence of schizophrenia and non-affective psychosis increased substantially in adolescence; however, the marked reduction in the proportion of those diagnosed with schizophrenia in this age group suggests a possible change in diagnostic practice.

Investigating amplitude of low-frequency fluctuation and possible links with cognitive impairment in childhood and adolescence onset schizophrenia: a correlation study

“…The rarity of CAOS is evident in a record-linkage study of hospital admissions in the UK. However, it is noteworthy that incidence rates of schizophrenia and non-affective psychoses have substantially increased among adolescents ( 12 ). Schizophrenia is widely regarded as a reflection of abnormal brain development, and its manifestation is particularly severe in patients with CAOS.…”

Clinical features and comorbidity in very early-onset schizophrenia: a systematic review

“…The first notable difference between these conditions is that, while EOS and AOS tend to exhibit varying frequency rates among sexes, no sex differences have been found with respect to the frequency of VEOS. A study conducted over a 15-year period on the entire English population by Seminog et al (14) revealed that sex differences in schizophrenia only emerge at around 14 years of age, revealing a progressively higher incidence in males compared to females. In contrast, in adulthood, schizophrenia is more frequent in males, although the prevalence of the disorder has shown minor differences, leading to some controversies in the field (14,(39)(40)(41)(42)(43).…”

“…However, a study by the NIMH indicated a VEOS prevalence rate of 1 in 40,000 ( 7 ). Another study examining the entire English population revealed an incidence rate of hospitalization for VEOS of 0.03 per 100,000 among males and 0.01 per 100,000 among females, with no significant difference between sexes ( 14 ). Moreover, the diagnosis of VEOS can be challenging for several reasons.…”

Autism spectrum disorder, very-early onset schizophrenia, and child disintegrative disorder: the challenge of diagnosis. A case-report study

“…CDD shares these features with SSD but not with ASD. Finally, CDD and ASD show a high frequency in males, and VEOS shows a similar frequency in males and females (differently from adolescent and adult schizophrenia, which are much more frequent in males) (20,27,28). In Table 1, the main differences between CDD, ASD, and VEOS, in terms of onset, gender, and symptomatology, are summarized.…”