0
0

Chapter 24. Early-Onset Schizophrenia

Jon S. Kuniyoshi, M.D., Ph.D.; Jon M. McClellan, M.D.
DOI: 10.1176/appi.books.9781585623921.461045

Sections

Excerpt

Schizophrenia is characterized by disturbances in perception, thought, emotion, affect, and social relatedness. Early-onset schizophrenia (EOS) is defined as onset prior to age 18 years, with childhood-onset schizophrenia (COS) referring to onset before age 13 years. EOS is considered to be continuous with adult-onset schizophrenia yet manifests with special developmental and social challenges. This chapter will provide information on history, etiology, neurobiological and genetic characteristics, clinical presentation, and an overview of psychosocial and pharmacological interventions to provide a basis for comprehensive care of children and adolescents with schizophrenia and related disorders.

Your session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Table Reference Number
TABLE 24–1. DSM-IV-TR diagnostic criteria for schizophrenia
Table Reference Number
TABLE 24–2. Differential diagnosis of early-onset schizophrenia
Table Reference Number
TABLE 24–3. Components of a diagnostic evaluation for patients with psychotic symptoms

References

American Academy of Child and Adolescent Psychiatry: Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry 37:63S–83S, 1998
 
American Academy of Child and Adolescent Psychiatry: Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry 40:4S–23S, 2001
 
American Academy of Child and Adolescent Psychiatry: Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 46:107–125, 2007
 
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
 
Bellack AS, Dickinson D, Morris SE, et al: The development of a computer-assisted cognitive remediation program for patients with schizophrenia. Isr J Psychiatry Relat Sci 42:5–14, 2005
[PubMed]
 
Bertrando P, Beltz J, Bressi C, et al: Expressed emotion and schizophrenia in Italy: a study of an urban population. Br J Psychiatry 161:223–229, 1992
[PubMed]
 
Bottas A, Cooke RG, Richter MA: Comorbidity and pathophysiology of obsessive-compulsive disorder in schizophrenia: is there evidence for a schizo-obsessive subtype of schizophrenia? J Psychiatry Neurosci 30:187–193, 2005
[PubMed]
 
Breitborde NJ, Lopez SR, Wickens TD, et al: Toward specifying the nature of the relationship between expressed emotion and schizophrenic relapse: the utility of curvilinear models. Int J Methods Psychiatr Res 16:1–10, 2007
[PubMed]
 
Brown RG, Pluck G: Negative symptoms: the "pathology" of motivation and goal-directed behaviour. Trends Neurosci 23:412–417, 2000
[PubMed]
 
Butzlaff RL, Hooley JM: Expressed emotion and psychiatric relapse: a meta-analysis. Arch Gen Psychiatry 55:547–552, 1998
[PubMed]
 
Calderoni D, Wudarsky M, Bhangoo R, et al: Differentiating childhood-onset schizophrenia from psychotic mood disorders. J Am Acad Child Adolesc Psychiatry 40:1190–1196, 2001
[PubMed]
 
Cannon M, Walsh E, Hollis C, et al: Predictors of later schizophrenia and affective psychosis among attendees at a child psychiatry department. Br J Psychiatry 178:420–426, 2001
[PubMed]
 
Cannon TD, Thompson PM, van Erp TG, et al: Cortex mapping reveals regionally specific patterns of genetic and disease-specific gray-matter deficits in twins discordant for schizophrenia. Proc Natl Acad Sci USA 99:3228–3233, 2002
[PubMed]
 
Cantor-Graae E, Selten JP: Schizophrenia and migration: a meta-analysis and review. Am J Psychiatry 162:12–24, 2005
[PubMed]
 
Caplan R, Guthrie D, Fish B, et al: The Kiddie Formal Thought Disorder Rating Scale: clinical assessment, reliability, and validity. J Am Acad Child Adolesc Psychiatry 28:408–416, 1989
[PubMed]
 
Cardno A, Gottesman II: Twin studies of schizophrenia: from bow-and-arrow concordances to star wars Mx and functional genomics. Am J Med Genet 97:12–17, 2000
[PubMed]
 
Clarke M, Whitty P, Browne S, et al: Untreated illness and outcome of psychosis. Br J Psychiatry 189:235–240, 2006
[PubMed]
 
Draguns JG, Tanaka-Matsumi J: Assessment of psychopathology across and within cultures: issues and findings. Behav Res Ther 41:755–776, 2003
[PubMed]
 
Eggers C: Schizo-affective psychoses in childhood: a follow-up study. J Autism Dev Disord 19:327–342, 1989
[PubMed]
 
Eggers C, Bunk D, Krause D: Schizophrenia with onset before the age of eleven: clinical characteristics of onset and course. J Autism Dev Disord 30:29–38, 2000
[PubMed]
 
Essock SM, Kontos N: Implementing assertive community treatment teams. Psychiatr Serv 46:679–683, 1995
[PubMed]
 
Fish B: Neurobiologic antecedents of schizophrenia in children: evidence for an inherited, congenital neurointegrative defect. Arch Gen Psychiatry 34:1297–1313, 1977
[PubMed]
 
Fish B, Kendler KS: Abnormal infant neurodevelopment predicts schizophrenia spectrum disorders. J Child Adolesc Psychopharmacol 15:348–361, 2005
[PubMed]
 
Frazier JA, McClellan J, Findling RL, et al: Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS): demographic and clinical characteristics. J Am Acad Child Adolesc Psychiatry 46:979–988, 2007
[PubMed]
 
Garralda ME: Hallucinations in children with conduct and emotional disorders, II: the follow-up study. Psychol Med 14:597–604, 1984
[PubMed]
 
Glynn SM, Cohen AN, Dixon LB, et al: The potential impact of the recovery movement on family interventions for schizophrenia: opportunities and obstacles. Schizophr Bull 32:451–463, 2006
[PubMed]
 
Gochman PA, Greenstein D, Sporn A, et al: IQ stabilization in childhood-onset schizophrenia. Schizophr Res 77:271–277, 2005
[PubMed]
 
Gogtay N, Giedd JN, Lusk L, et al: Dynamic mapping of human cortical development during childhood through early adulthood. Proc Natl Acad Sci U S A 101:8174–8179, 2004a
 
Gogtay N, Sporn A, Clasen LS, et al: Comparison of progressive cortical gray matter loss in childhood-onset schizophrenia with that in childhood-onset atypical psychoses. Arch Gen Psychiatry 61:17–22, 2004b
 
Gothelf D, Feinstein C, Thompson T, et al: Risk factors for the emergence of psychotic disorders in adolescents with 22q11.2 deletion syndrome. Am J Psychiatry 164:663–669, 2007
[PubMed]
 
Green WH, Campbell M, Hardesty AS, et al: A comparison of schizophrenic and autistic children. J Am Acad Child Psychiatry 23:399–409, 1984
[PubMed]
 
Green WH, Padron-Gayol M, Hardesty AS, et al: Schizophrenia with childhood onset: a phenomenological study of 38 cases. J Am Acad Child Adolesc Psychiatry 31:968–976, 1992
[PubMed]
 
Greenough WT, Black JE, Wallace CS: Experience and brain development. Child Dev 58:539–559, 1987
[PubMed]
 
Greenstein D, Lerch J, Shaw P, et al: Childhood-onset schizophrenia: cortical brain abnormalities as young adults. J Child Psychol Psychiatry 47:1003–1012, 2006
[PubMed]
 
Grossman AW, Churchill JD, McKinney BC, et al: Experience effects on brain development: possible contributions to psychopathology. J Child Psychol Psychiatry 44:33–63, 2003
[PubMed]
 
Gur RE, Cowell P, Turetsky BI, et al: A follow-up magnetic resonance imaging study of schizophrenia: relationship of neuroanatomical changes to clinical and neurobehavioral measures. Arch Gen Psychiatry 55:145–152, 1998
[PubMed]
 
Gur RE, Cowell PE, Latshaw A, et al: Reduced dorsal and orbital prefrontal gray matter volumes in schizophrenia. Arch Gen Psychiatry 57:761–768, 2000
[PubMed]
 
Harrison PJ, Weinberger DR: Schizophrenia genes, gene expression, and neuropathology: on the matter of their convergence. Mol Psychiatry 10:40–68, 2005
[PubMed]
 
Hlastala SA, McClellan J: Phenomenology and diagnostic stability of youths with atypical psychotic symptoms. J Child Adolesc Psychopharmacol 15:497–509, 2005
[PubMed]
 
Hooley JM, Campbell C: Control and controllability: beliefs and behaviour in high and low expressed emotion relatives. Psychol Med 32:1091–1099, 2002
[PubMed]
 
Horan WP, Ventura J, Nuechterlein KH, et al: Stressful life events in recent-onset schizophrenia: reduced frequencies and altered subjective appraisals. Schizophr Res 75:363–374, 2005
[PubMed]
 
Huxley NA, Rendall M, Sederer L: Psychosocial treatments in schizophrenia: a review of the past 20 years. J Nerv Ment Dis 188:187–201, 2000
[PubMed]
 
Jones PB, Barnes TR, Davies L, et al: Randomized controlled trial of the effect on quality of life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1). Arch Gen Psychiatry 63:1079–1087, 2006
[PubMed]
 
Kahn RS, Fleischhacker WW, Boter H, et al: Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet 371:1085–1097, 2008
[PubMed]
 
Kolvin I: Studies in the childhood psychoses, I: diagnostic criteria and classification. Br J Psychiatry 118:381–384, 1971
[PubMed]
 
Kumra S, Frazier JA, Jacobsen LK, et al: Childhood-onset schizophrenia: a double-blind clozapine-haloperidol comparison. Arch Gen Psychiatry 53:1090–1097, 1996
[PubMed]
 
Kumra S, Oberstar JV, Sikich L, et al: Efficacy and tolerability of second-generation antipsychotics in children and adolescents with schizophrenia. Schizophr Bull 34:60–71, 2008
[PubMed]
 
Lehman AF: Public health policy, community services, and outcomes for patients with schizophrenia. Psychiatr Clin North Am 21:221–231, 1998
[PubMed]
 
Lehman AF, Lieberman JA, Dixon LB, et al: Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry 161:1–56, 2004
[PubMed]
 
Lewandowski KE, Shashi V, Berry PM, et al: Schizophrenic-like neurocognitive deficits in children and adolescents with 22q11 deletion syndrome. Am J Med Genet B Neuropsychiatr Genet 144:27–36, 2007
 
Lieberman JA, Stroup TS, McEvoy JP, et al: Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 353:1209–1223, 2005
[PubMed]
 
Lohmueller KE, Pearce CL, Pike M, et al: Meta-analysis of genetic association studies supports a contribution of common variants to susceptibility to common disease. Nat Genet 33:177–182, 2003
[PubMed]
 
Lopez SR, Nelson Hipke K, Polo AJ, et al: Ethnicity, expressed emotion, attributions, and course of schizophrenia: family warmth matters. J Abnorm Psychol 113:428–439, 2004
[PubMed]
 
Loranger AW: Sex difference in age at onset of schizophrenia. Arch Gen Psychiatry 41:157–161, 1984
[PubMed]
 
Maynard TM, Haskell GT, Peters AZ, et al: A comprehensive analysis of 22q11 gene expression in the developing and adult brain. Proc Natl Acad Sci U S A 100:14433–14438, 2003
[PubMed]
 
McClellan J, McCurry C: Neurodevelopmental Pathways in Schizophrenia. Semin Clin Neuropsychiatry 3:320–332, 1998
[PubMed]
 
McClellan J, McCurry C: Early-onset psychotic disorders: diagnostic stability and clinical characteristics. Eur Child Adolesc Psychiatry 8(suppl):I13–19, 1999
 
McClellan J, Werry JS, Ham M: A follow-up study of early-onset psychosis: comparison between outcome diagnoses of schizophrenia, mood disorders, and personality disorders. J Autism Dev Disord 23:243–262, 1993
[PubMed]
 
McClellan J, McCurry C, Snell J, et al: Early-onset psychotic disorders: course and outcome over a 2-year period. J Am Acad Child Adolesc Psychiatry 38:1380–1388, 1999
[PubMed]
 
McClellan J, McCurry C, Speltz ML, et al: Symptom factors in early-onset psychotic disorders. J Am Acad Child Adolesc Psychiatry 41:791–798, 2002
[PubMed]
 
McClellan J, Breiger D, McCurry C, et al: Premorbid functioning in early-onset psychotic disorders. J Am Acad Child Adolesc Psychiatry 42:666–672, 2003
[PubMed]
 
McClellan J, Susser E, King MC: Maternal famine, de novo mutations, and schizophrenia. JAMA 296:582–584, 2006
[PubMed]
 
McClellan J, Sikich L, Findling RL, et al: Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS): rationale, design, and methods. J Am Acad Child Adolesc Psychiatry 46:969–978, 2007a
 
McClellan J, Susser E, King MC: Schizophrenia: a common disease caused by multiple rare alleles. Br J Psychiatry 190:194–199, 2007b
 
Mehler C, Warnke A: Structural brain abnormalities specific to childhood-onset schizophrenia identified by neuroimaging techniques. J Neural Transm 109:219–234, 2002
[PubMed]
 
Mueser KT, Bond GR, Drake RE, et al: Models of community care for severe mental illness: a review of research on case management. Schizophr Bull 24:37–74, 1998
[PubMed]
 
Narr KL, Bilder RM, Toga AW, et al: Mapping cortical thickness and gray matter concentration in first episode schizophrenia. Cereb Cortex 15:708–719, 2005a
 
Narr KL, Toga AW, Szeszko P, et al: Cortical thinning in cingulate and occipital cortices in first episode schizophrenia. Biol Psychiatry 58:32–40, 2005b
 
O'Brien MP, Gordon JL, Bearden CE, et al: Positive family environment predicts improvement in symptoms and social functioning among adolescents at imminent risk for onset of psychosis. Schizophr Res 81:269–275, 2006
[PubMed]
 
Owen MJ, Williams NM, O'Donovan MC: The molecular genetics of schizophrenia: new findings promise new insights. Mol Psychiatry 9:14–27, 2004
[PubMed]
 
Pilling S, Bebbington P, Kuipers E, et al: Psychological treatments in schizophrenia, I: meta-analysis of family intervention and cognitive behaviour therapy. Psychol Med 32:763–782, 2002
[PubMed]
 
Rapoport JL, Giedd J, Kumra S, et al: Childhood-onset schizophrenia: progressive ventricular change during adolescence. Arch Gen Psychiatry 54:897–903, 1997
[PubMed]
 
Rapoport JL, Addington AM, Frangou S, et al: The neurodevelopmental model of schizophrenia: update 2005. Mol Psychiatry 10:434–449, 2005
[PubMed]
 
Rosenfarb IS, Bellack AS, Aziz N: Family interactions and the course of schizophrenia in African American and White patients. J Abnorm Psychol 115:112–120, 2006
[PubMed]
 
Ross RG, Heinlein S, Tregellas H: High rates of comorbidity are found in childhood-onset schizophrenia. Schizophr Res 88:90–95, 2006
[PubMed]
 
Rund BR: Cognitive dysfunctions and psychosocial treatment of schizophrenics: research of the past and perspectives on the future. Acta Psychiatr Scand Suppl 384:9–16, 1994
[PubMed]
 
Rutter M: Childhood schizophrenia reconsidered. J Autism Child Schizophr 2:315–337, 1972
[PubMed]
 
Sanders AR, Duan J, Levinson DF, et al: No significant association of 14 candidate genes with schizophrenia in a large European ancestry sample: implications for psychiatric genetics. Am J Psychiatry 165:497–506, 2008
[PubMed]
 
Seedat S, Stein MB, Oosthuizen PP, et al: Linking posttraumatic stress disorder and psychosis: a look at epidemiology, phenomenology, and treatment. J Nerv Ment Dis 191:675–681, 2003
[PubMed]
 
Shaw P, Sporn A, Gogtay N, et al: Childhood-onset schizophrenia: a double-blind, randomized clozapine-olanzapine comparison. Arch Gen Psychiatry 63:721–730, 2006
[PubMed]
 
Spauwen J, Krabbendam L, Lieb R, et al: Does urbanicity shift the population expression of psychosis? J Psychiatr Res 38:613–618, 2004
[PubMed]
 
Sporn AL, Greenstein DK, Gogtay N, et al: Progressive brain volume loss during adolescence in childhood-onset schizophrenia. Am J Psychiatry 160:2181–2189, 2003
[PubMed]
 
St. Clair D, Xu M, Wang P, et al: Rates of adult schizophrenia following prenatal exposure to the Chinese famine of 1959–1961. JAMA 294:557–562, 2005
 
Sullivan PF, Lin D, Tzeng JY, et al: Genomewide association for schizophrenia in the CATIE study: results of stage 1. Mol Psychiatry 13:570–584, 2008
[PubMed]
 
Susser E, Neugebauer R, Hoek HW, et al: Schizophrenia after prenatal famine: further evidence. Arch Gen Psychiatry 53:25–31, 1996
[PubMed]
 
Tarrier N, Barrowclough C, Porceddu K, et al: The Salford Family Intervention Project: relapse rates of schizophrenia at five and eight years. Br J Psychiatry 165:829–832, 1994
[PubMed]
 
Thompson PM, Vidal C, Giedd JN, et al: Mapping adolescent brain change reveals dynamic wave of accelerated gray matter loss in very early-onset schizophrenia. Proc Natl Acad Sci U S A 98:11650–11655, 2001
[PubMed]
 
Thomsen PH: Schizophrenia with childhood and adolescent onset: a nationwide register-based study. Acta Psychiatr Scand 94:187–193, 1996
[PubMed]
 
Toga AW, Thompson PM, Sowell ER: Mapping brain maturation. Trends Neurosci 29:148–159, 2006
[PubMed]
 
Vidal CN, Rapoport JL, Hayashi KM, et al: Dynamically spreading frontal and cingulate deficits mapped in adolescents with schizophrenia. Arch Gen Psychiatry 63:25–34, 2006
[PubMed]
 
Volkmar FR, Cohen DJ: Comorbid association of autism and schizophrenia. Am J Psychiatry 148:1705–1707, 1991
[PubMed]
 
Waddington JL, Lane A, Larkin C, et al: The neurodevelopmental basis of schizophrenia: clinical clues from cerebro-craniofacial dysmorphogenesis, and the roots of a lifetime trajectory of disease. Biol Psychiatry 46:31–39, 1999
[PubMed]
 
Waddington JL, Scully PJ, Quinn JF, et al: The origin and course of schizophrenia: implications for clinical practice. J Psychiatr Pract 7:247–252, 2001
[PubMed]
 
Walsh T, McClellan JM, McCarthy SE, et al: Rare structural variants disrupt multiple genes in neurodevelopmental pathways in schizophrenia. Science 320:539–543, 2008
[PubMed]
 
Wearden AJ, Tarrier N, Barrowclough C, et al: A review of expressed emotion research in health care. Clin Psychol Rev 20:633–666, 2000
[PubMed]
 
Werry JS, McClellan JM, Chard L: Childhood and adolescent schizophrenic, bipolar, and schizoaffective disorders: a clinical and outcome study. J Am Acad Child Adolesc Psychiatry 30:457–465, 1991
[PubMed]
 
Westermeyer J: Comorbid schizophrenia and substance abuse: a review of epidemiology and course. Am J Addict 15:345–355, 2006
[PubMed]
 
Xu B, Roos JL, Levy S, et al: Strong association of de novo copy number mutations with sporadic schizophrenia. Nat Genet 40:880–885, 2008
[PubMed]
 
+

CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
All of the following statements regarding early-onset schizophrenia (EOS) are correct except
2.
All of the following statements regarding the etiology of early-onset schizophrenia (EOS)/childhood-onset schizophrenia (COS) are correct except
3.
In regard to differences between early-onset schizophrenia (EOS) and adult-onset schizophrenia (AOS), all of the following statements are correct except
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Related Content
Articles
Books
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 1.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 2.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 3.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 4.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 5.  >
Topic Collections
Psychiatric News
PubMed Articles
Executive attention impairment in adolescents with schizophrenia who have used cannabis. Schizophr Res 2014;():.doi:10.1016/j.schres.2014.04.035.
Antipsychotics use in children and adolescents: An on-going challenge in clinical practice. J Psychopharmacol 2014;28(7):615-623.doi:10.1177/0269881114533599.
 
  • Print
  • PDF
  • E-mail
  • Chapter Alerts
  • Get Citation