Back to: Detlef Bunk publications Symposium Early Onset Schizophrenia. Phenomenology, Course, and Outcome University of Essen, Germany, July 31, 1998 and IACAPAP Stockholm August 2, 1998 Prof. Dr. med. Christian Eggers, Dr. phil. Detlef Bunk Published in: J. Europ.Child & Adolesc.Psychiatry, 1999, 8: suppl.1 Some remarks on etiological aspects of early onset schizophrenia Christian Eggers, Prof. Dr. med.
Clinic for Child and Adolescent Psychiatry, University
Essen Neurophysiological,
neuropsychological, neuroanatomical and neuroradiological findings in
schizophrenic psychoses demonstrate that subcortical (e. g. mesolimbic and
diencephalic regions) as well as neocortical structures (e. g.
dorsolateral prefronatal cortex, superior temporal and inferior parietal
cortices) are involved. Special significance is accorded to the
neuroanatomical connection between limbic structures and the dorsolateral
prefrontal cortex. Here myelinization begins relatively late in humans,
during the second and third decade of life – a particularly vulnerable
period for schizophrenic onset. The nature of prepsychotic behavioural
abnormalities in patients with early onset schizophrenia as well as the
existence of typical cognitive dysfunctions preceding the manifestation of
psychotic symptoms points to the importance of a dynamic imbalance of
neocortical-subcortical interactions in the aetiology of schizophrenia.
Based on the crucial importance of the prefrontal-hippocampal circuitry a
stimulus barrier model of schizophrenic psychoses is elaborated, which
integrates recent neurobiological findings as well as results of research
in modern developmental psychology. One of the implications of this model
is the multidimensional treatment of schizophrenic patients.
Childhood-onset Schizophrenia: A follow-up Study Joan R. Asarnow, Ph.D.
UCLA School of Medicine, Neuropsychiatric Institute, Los
Angeles The main
results from the UCLA Follow-up Study of Childhood-onset Schizophrenia
Spectrum Disorders are presented. Eighteen children with schizophrenia
(SZ) were assessed 1 to 7 years following initial project intake. Results
demonstrated significant continuity between SZ spectrum disorder in
childhood and adolescence Although not all children who were presented
initially with SZ continued to meet criteria for SZ spectrum disorder as
they progressed through the follow-up period., rates of SZ spectrum
disorder ranged from 78% to 89% across the first three follow-up years.
Rates of continuing SZ ranged from 67% to 78% across the three follow-up
years and rates of schizoaffective disorder ranged from 11% to 13% across
the three follow-up years. Variability in levels of functioning were
observed with 45% of the sample showing deteriorating course or minimal
improvement and 55% of the sample showing moderate improvement. Or good
outcome. The variability in outcome is comparable to that seen in adults
with SZ, suggesting that with current treatments childhood-onset does not
ensure a more severe disorder.
The Ontogeney of Schizophrenia Robert F. Asarnow, Ph.D., Della Martin, Professor of
Psychiatry Professor of Psychology
Department of Psychiatry. University of California-Los
Angeles This paper
is a review of studies examining the neurobehavioral antecedents of
schizophrenia which flesh out neuordevelopmental models of schizophrenia
by detailing the time course of the ontogeney of neurobehavioral
impairments in schizophrenia. A follow back design was used to identify
precursors of psychotic symptoms in children with a schizophrenic
disorder. The vast majority of children with a schizophrenic disorder had
significant developmental delays beginning early in life. For
example, gross deficits in early language development were
found in almost 80% of the schizophrenic children. Somewhat later in
development impairments in fine motor and bi-manual coordination are
noted. Some of these early developmental delays are transitory. For
example, basic language skills are among the best preserved neurocognitive
functions in children and adults with schizophrenia. The results of our
cross-sectional neurocognitive studies suggest that children with
schizophrenia suffer from limitations in the ability to engage in
effortful cognitive processing or impairments in working memory. The
links between these elementary neurocognitive impairments and the
development of formal thought disorder as well as discourse deficits in
children with a schizophrenic disorder will be discussed.
Early Onset Psychotic Disorders: Diagnostic Stability and Clinical Characteristics Jon McClellan, M.D., Assistant Professor, Chris McCurry,
Ph.D.
University of Washington's Department of Psychiatry,
Seattle, WA Objectives: To examine the clinical
features and diagnostic stability of early-onset psychotic disorders.
Methods: These data are from a two-year longitudinal
prospective study of youth with psychotic disorders. Standardized
diagnostic assessments are administered at baseline, and at one and two
year's follow-up.
Results: Forty-eight subjects have been recruited to
date; 17 with schizophrenia, 13 with bipolar disorder, 10 with psychosis
not otherwise specified (nos), 7 with schizoaffective disorder, and 1 with
an organic psychosis. Thirty-two subjects have been reassessed at
year one; twenty at year two. Two subjects have been lost to
follow-up. The study diagnosis was the same as the first onset
diagnosis (prior to entering the study) in 56 percent of subjects. Two
subjects received a different study diagnosis at year one, one of whom
reverted back at year two. Subjects with schizophrenia had higher ratings
of premorbid social withdrawal and dysfunctional peer relationships. At
the one-year follow-up, subjects with bipolar disorder were functioning
significantly better than subjects with either schizophrenia, or psychosis
nos. All groups had high rates of comorbid behavior disorders and
substance abuse. Subjects with psychosis nos had questionable
psychotic symptoms, higher rates of dissociative symptoms, and an
increased history of sexual abuse.
Conclusions: Early-onset psychotic disorders
can be reliably diagnosed using standardized assessments, and are stable
over a two-year period. Compared to bipolar disorder, schizophrenia is
associated with a poorer premorbid history, and greater dysfunction at
outcome.
Premorbid functioning and liftime course of early onset psychotic disorder Christian Eggers, Prof. Dr. med, Detlef Bunk,
Dr. phil.
Clinic for Child and Adolescent psychiatry, University
Essen Summarized case
histories of a subsample of eleven cases from a total of 44 patients of a
long-term follow-up study are presented. The lifetime psychopathological
development of these cases of early onset schizophrenia (EOS) is described
in terms of premorbid behavioral disturbances and the subtypes of
the following psychotic episodes until late adult life. The results show
that behavioral peculiarities like shyness, social withdrawal, bizarre
behavior, .aggression, and anxiety already occurred in early childhood
long before definite psychotic symptoms were observed. The heterogeneity
of psychotic episodes in the following lifetime course led to the
conclusion that illness courses are better qualified for the description
of symptoms over time than for diagnostic classifications.
Symtom Dimensions in The Course of Early Onset Schizophrenia Detlef Bunk, Dr. phil, Christian Eggers, Prof. Dr. med.,
Marion Klapal, Dipl.-Psych.
Clinic for child and adolescent psychiatry, University
Essen Objective: This study is a symptom
orientated approach to describe the symptom dimensions of Childhood-onset
schizophrenia (COS) cross-sectionally and longitudinally by focussing on
the clinical features at onset of illness during the first episode and at
the follow-up after an average time of 42 years from the begin of illness.
Stability and change of these dimensions should be examined and related to
the outcome variable representing the level of the psycho-social
functioning.
Method: The sample comprises 44 patient with COS.
Clinical data of the whole course were available from hospital records
applying the IRAOS. The Present State Examination (PSE) together with the
Disability Assessment Score (DAS-M) at follow-up investigation. All
subjects were re-diagnosed according to DSM IV. The symptomatology was
evaluated with the positive and negative symptom scale (PANSS) at onset
and follow-up examination. Because of the retrospective assessment this
scale was applied categorically (presence/absence of symptom). Two
principal component factor analysis with varimax-rotation were applied to
the complete items set of the PANSS. The two sets of factor scores were
correlated with the outcome variables (DAS-M). The frequency of positive,
negative, and global symptoms were compared longitudinally in an
ANOVA-repeated measures design.
Results: The factor analysis revealed 5 orthogonal
symptom dimensions (factors) at onset of psychoses: Cognition, social
withdraw, anti-social behavior, excitement, and reality distortion. At the
follow-up a five-factor solution was found too but with different
dimensions: positive, negative, excitement, cognitive and
anxiety/depression component. Social withdrawal at onset was significantly
correlated to a low level of psycho-social adaptation at follow up.
Positive symptoms decreased significantly during the course of illness,
while the frequencies of negative and global symptoms did not change.
Conclusion: COS is accompanied with more unspecific
symptoms because of its deteriorating impact on the entire childhood
developmental process. So the factor structure is predominated by the
dimensions of social withdrawal and antisocial behavior. In the later
course of illness the structure of symptom dimensions changes to that
found in adult schizophrenia. The negative symptoms, observed at the begin
of COS seem to have a reliable prognostic value for course and outcome.
Childhood-onset schizophrenia and affective psychoses: the predictors and features of outcome in adult life Chris Hollis, Ph.D.
Department of Child & Adolescent Psychiatry,
University Hospital Nottingham, NG7 2UJI, U.K Objective: The aim of this clinical
follow-up study of chi1dhood-onset functional psychoses was to examine
whether diagnostic categories and symptom dimensions at presentation
predict outcome in adult life after contro1ling for age at onset.
Methods: The study sample consisted of a consecutive
series of 115 patients, aged 1.6 years or younger, admitted to the
Maudsley and Bethlem Royal Hospitals, London between 1975 anti 1990 with
DSM-IIIR schizophrenia or an affective psychosis. Full follow-up was
achieved for 71 subjects (41 with schizophrenia, 30 with affective
psychoses). Results : The schizophrenic and affective psychosis
groups were similar with respect to background demographic features, age
at onset of psychotic symptoms (mean 14.7 years for both groups) and
duration of follow-up (mean 11.9 vs. 10~6 years respectively). At
follow-up, the schizophrenic subjects had experienced a significantly
longer period with active psychotic symptoms (mean 9.0 vs. 2.3 years) anti
spent longer in hospital (mean 4.7 vs. 2.3 years). The schizophrenic
subjects were less likely than the affective psychotic group to be living
independently (7% vs. 64%), to be in employment (10% vs. 47%) and to have
established close love relationships or friendships (17% vs. 66%). The
strongest predictor of poor outcome was the negative symptoms at
presentation. The positive symptom dimension (hallucinations, delusions)
was unrelated to outcome.
Conclusion: Childhood-onset schizophrenia has a
significantly worse clinical and social outcome when compared to
childhood-onset affective psychoses. Poor outcome, regardless of
diagnosis, is best predicted by a pattern of premorbid behavioral,
cognitive and social impairments and negative psychotic symptoms. |
Pressemitteilung 10.08.1998 - (idw) Universität Essen (bis 31.12.2002)Schizophrenie-Forschung: Bei Erkrankung im Kindesalter
eine schlechte Prognose
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