Research Update: Childhood‐onset Schizophrenia: Implications of Clinical and Neurobiological Research

Abstract

Childhood-onset schizophrenia is a rare, clinically severe form of schizophrenia, which is associated with disrupted cognitive, linguistic, and social development well before the appearance of frank psychotic symptoms. This disruption of multiple developmental domains signals the important opportunity these patients present for examining neurodevelopmental and other etiologic hypotheses of schizophrenia. The present research update reviews studies of the phenomenology and neurobiology of childhood-onset schizophrenia conducted since 1994. Findings from these studies indicate that children can be diagnosed with schizophrenia using unmodified DSM-III, -IIIR, and -IV criteria, and that the atypical neuroleptic clozapine is an effective medication for this treatment refractory group. Neuropsychologic and neurobiologic studies generally support continuity with adult-onset schizophrenia, with evidence of more severe premorbid impairment. Longitudinal studies show preliminary evidence of progressive ventricular enlargement and more prolonged deterioration in intellectual function than is seen in the adult-onset disorder. If replicated, these observations, together with the insidious onset of this disorder, would suggest that the pathologic underpinning of childhood-onset schizophrenia is not a single static lesion or event but may be a continuous or multi-event process.

Aberrant localization of synchronous hemodynamic activity in auditory cortex reliably characterizes schizophrenia

“…A recent longitudinal and cross-sectional analysis of subjects who later developed psychosis demonstrated significant gray matter loss in right STG (Pantelis et al 2003). Jacobsen and Rapoport (1998), in a study of childhood-onset schizophrenia, showed significantly greater decreases in right temporal lobe, bilateral STG, posterior STG, and right anterior STG volumes.…”

Deficient maturation of aspects of attention and executive functions in early onset schizophrenia

“…Childhood-onset of schizophrenia (COS, onset by age 12) [39] is extremely rare [12;80], whereas the incidence increases between the ages 13 to 17 years [70 ;80]. A study including COS, also termed very earlyonset schizophrenia [39], observed cognitive deficits of comparable severity to those of patients with onset of schizophrenia between the ages of 13 and 18 years [71], and consequently, no distinction is made between COS and EOS patients in this paper.…”

“…Childhood-onset of schizophrenia (COS, onset by age 12) [39] is extremely rare [12;80], whereas the incidence increases between the ages 13 to 17 years [70 ;80]. A study including COS, also termed very earlyonset schizophrenia [39], observed cognitive deficits of comparable severity to those of patients with onset of schizophrenia between the ages of 13 and 18 years [71], and consequently, no distinction is made between COS and EOS patients in this paper. Previous controlled studies of EOS patients and adolescent patients with schizophrenia spectrum disorders have reported significant deficits in several specific cognitive functions such as speed of processing, attention, verbal memory, aspects of executive functions including mental flexibility and working memory, etc.…”

Theory of Mind in the Early Course of Schizophrenia

“…Furthermore, patients with EOS demonstrate significant cognitive impairments in specific domains, mainly general intellectual ability [36][37][38][39][40][41][42], memory [43][44][45][46][47], attention [43,48,49], and executive function [46,48,50,51]. Studying early-onset cases may provide important insights into the etiopathogenesis of the disorder [50][51].…”

“…Studying early-onset cases may provide important insights into the etiopathogenesis of the disorder [50][51]. However, there has been limited research addressing impairments in social cognition in young people with schizophrenia.…”