Long-term course of adolescent schizophrenia

Department of Child and Adolescent Psychiatry, Albert Ludwigs University Freiburg, Hauptstr. 8, D-79104 Freiburg, Germany.
Schizophrenia Bulletin (Impact Factor: 8.45). 08/2005; 31(3):769-80. DOI: 10.1093/schbul/sbi014
Source: PubMed


Our study investigated premorbid functioning, course, and outcome in early-onset schizophrenia. All inpatients with DSM-III-R diagnoses of schizophrenia (n = 101) consecutively admitted between 1983 and 1988 to the Department of Child and Adolescent Psychiatry at the University of Marburg in Germany were included. To assess premorbid adaptation and precursor symptoms, we administered the Instrument for the Retrospective Assessment of the Onset of Schizophrenia, which we modified to assess children and adolescents. Symptomatology was measured by the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms, and the Brief Psychiatric Rating Scale. In addition, the Global Assessment of Functioning was applied. Followup data for 81 patients (80.2%) were available. The mean duration of schizophrenia at followup was 9.5 +/- 2.2 years. Assessment of the highest level of adaptive functioning revealed very good or good outcome in 19.8 percent of the patients, fair or poor outcome in 38.2 percent, and very poor outcome and gross impairment in 42.0 percent. Premorbid adjustment was the best predictor of outcome in our schizophrenia sample. A poor prognosis was found in patients with premorbid developmental delays and those who were introverted and withdrawn before their psychotic state.

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    • "Early onset schizophrenia (EOS; defined as onset of psychotic symptoms by age 18) is a less frequent and, in some cases, more severe variant of the disorder than its adult-onset counterpart (Asarnow et al., 1994; Nicolson et al., 2000; Vyas et al., 2010a). EOS shows diagnostic continuity with adult-onset schizophrenia (Nicolson and Rapoport, 1999; Asarnow et al., 2001; Nicolson et al., 1999, 2003; Gochman et al., 2004), but may be associated with delay in crucial developmental stages, increased rate of cytogenetic anomalies, greater clinical severity and worse functional outcome (Hollis, 2000; Fleischhaker et al., 2005; Vyas et al., 2007, 2012a; Rapoport et al., 2012; Vyas and Gogtay, 2012). Generalized cognitive deficits have been reported in adolescents with EOS across a broad array of ability domains; the largest effect sizes being reported in general intellectual ability, verbal learning and memory, and executive function (Kenny et al., 1997; Roofeh et al., 2006; Vyas et al., 2010b). "
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    ABSTRACT: A common T/C polymorphism within the ninth intron of the KIBRA gene (rs17070145) is thought to influence memory in humans. Since cognitive impairment, including memory, is a core feature of schizophrenia, we attempted to investigate this association in an independent sample of adolescent patients with early-onset schizophrenia (EOS; onset before age 18) probands and their healthy siblings. In a sample of 25 pairs of EOS proband-healthy full sibling, we sought to investigate the association of KIBRA with memory performance. Episodic memory was measured using immediate and delayed recall measures of the California Verbal Learning Test. EOS underperformed at immediate and delayed recall compared with siblings. In a combined analysis (TT vs. TC/CC) assuming a C dominant model of inheritance, we found a main effect of genotype where individuals with TT genotype outperformed non-TT-carriers at immediate and delayed recall. A genotype by group interaction showed that EOS with TT genotype did not show a memory advantage over siblings with TT or non-TT-carriers at immediate or delayed recall. Siblings with TT genotype showed enhanced immediate recall (not delayed recall) compared with non-TT-carriers. This study demonstrates an association between the KIBRA gene and episodic memory (immediate free recall) and suggests a differential effect of this genetic variant in EOS and healthy siblings.
    Psychiatry Research 07/2014; 220(1-2). DOI:10.1016/j.psychres.2014.07.024 · 2.47 Impact Factor
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    • "EOS patients have been the focus of substantial interest, since studies of patients with adolescent onset could provide insights into the development of the disorder, in particular the interaction between normal maturational processes and the disorder. EOS is usually considered a more severe form compared to AOS, with more premorbid impairments and a poorer clinical course and outcome (Fleischhaker et al., 2005; Vyas et al., 2007) even if recent studies find limited differences in clinical course (Pencer et al., 2005; Amminger et al., 2011). "
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    ABSTRACT: Background: The goal of this study was to investigate differences in executive functioning between patients with early-onset and adult-onset schizophrenia spectrum psychoses at the time of first treatment. Methods: Neuropsychological tests covering executive functioning domains were performed for 20 adolescents with early-onset schizophrenia (EOS) close to first treatment and 90 first episode patients with adult onset schizophrenia (AOS) in addition to 66 adolescent- and 127 adult age and gender matched healthy controls. Results: Both EOS and AOS patients had significantly poorer executive performance than their age- and gender matched healthy counterparts. Both healthy adolescent controls and EOS patients had poorer executive performance than their adult counterparts. However, there were no differences in executive functioning between EOS and AOS patients after controlling for the levels of their age matched healthy control groups. Substituting EOS/AOS status with other age-at-onset thresholds had no effect. Conclusions: We find the same relative levels of executive dysfunction in EOS- and AOS groups at the time of first treatment. This does not necessarily contradict previous findings of more severe dysfunction in EOS patients over time, but indicates an interaction between the disorder and the maturational processes that only can be investigated through longitudinal studies.
    Schizophrenia Research 10/2012; 142(1-3). DOI:10.1016/j.schres.2012.10.006 · 3.92 Impact Factor
    • "A mean age of ≤18 years was required. The majority of the studies only included patients aged <18 years with just a few studies also including 18 year olds [5,11,49,50], one study including patients aged 19 years [6], and one study [32] including a few patients aged 20 years at the time of onset; however the latter study was included because of a mean age at onset of 16.8 years. Studies reporting data on pure EOS and studies reporting combined data on EOS and other psychotic illnesses (MIX) were included in the analyses. "
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    ABSTRACT: The current review analyzes the long-term outcome and prognosis of early onset schizophrenia based on previously published studies in 1980. A systematic search of articles published in the English-language literature after 1980 identified a total of 21 studies, which included 716 patients who were either suffering from early onset schizophrenia (EOS) or both EOS and other psychotic disorders (MIX). The authors of the current review scored the outcome as either “good,” “moderate,” or “poor.” The mean age of onset in these studies was <18 years. In general, the outcome in studies with EOS is worse than the outcome in MIX studies. Only 15.4% of the patients in EOS studies versus 19.6% of the patients in MIX studies experienced a “good” outcome. In contrast, 24.5% of the patients in EOS studies versus 33.6% in MIX studies experienced a “moderate” outcome, and 60.1% in EOS studies versus 46.8% in MIX studies experienced a “poor” outcome. The authors identified various significant effects on outcome. In EOS, the findings were significantly affected by sample attrition, indicating that in studies with a high dropout rate, fewer patients experienced a “moderate” outcome, and more patients experienced a “poor” outcome; however, the effect sizes were small. Furthermore, the effects were also small and more favourable for specific functioning measures, as opposed to more global measures, small to moderate in terms of worse outcomes for follow-up periods >10 years, small to moderate for more unfavourable outcomes in males, and small to large for worse outcomes in studies including patients diagnosed before 1970. In contrast to the adult manifestation, the early manifestation of schizophrenia in childhood and adolescence still carries a particularly poor prognosis. According to these aggregated data analyses, longer follow-up periods, male sex, and patients having been diagnosed before 1970 contribute predominantly to the rather poor course of EOS.
    BMC Psychiatry 09/2012; 12(1):150. DOI:10.1186/1471-244X-12-150 · 2.21 Impact Factor
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