Childhood-onset schizophrenia: premorbid and prodromal diagnostic and treatment histories.
OBJECTIVE
There is increasing interest in the possible relationship between the early diagnosis and treatment of schizophrenia during adolescence and improved long-term outcome. This study reviews the premorbid and prodromal diagnostic and treatment histories for childhood-onset schizophrenia, to assess whether early identification and treatment is possible in this school-age group.


METHODS
Parents of 17 children with childhood-onset schizophrenia or schizoaffective disorder were questioned retrospectively regarding symptoms, exposure to mental health professionals, diagnoses, and treatments.


RESULTS
Initial presenting symptoms clustered around violent aggression and school problems. Age of first recognized psychotic symptoms ranged from 2 to 11 years, followed 2.0+/-2.0 years later by a diagnosis of schizophrenia. Prior to a schizophrenia diagnosis, these children were exposed to stimulants, antidepressants, lower-dose typical neuroleptics, mood stabilizers, alternative treatments, and individual and family therapy.


CONCLUSIONS
Early diagnosis of childhood-onset schizophrenia is met with caution in the psychological and medical community. These children received many diagnoses before schizophrenia or schizoaffective disorder was diagnosed. A diagnosis of schizophrenia or schizoaffective disorder and utilization of effective atypical neuroleptic treatment was delayed until evaluation by a child and adolescent psychiatrist. Obstacles to early identification and treatment are discussed.
Schaeffer
John L
JL
Department of Psychiatry, Denver Veterans Administration Medical Center, CO 80262, USA.
Ross
Randal G
RG
D000293:Adolescent; D002648:Child; D003131:Combined Modality Therapy; D000529:Complementary Therapies; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D012189:Retrospective Studies; D012561:Schizophrenia, Childhood / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D012569:Schizotypal Personality Disorder / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy