Abstract
The study describes the psychopathological and social outcome of patients treated for schizophrenia in adolescence (mean age at onset 16.0 years/SD 1.52) after a mean follow-up period of 15.4 years (10.2–21.2 years). Out of 55 patients consecutively admitted to hospital, 47 (85 %) could be traced and 39 (71 %) could be re-examined.
At follow-up, 33/39 patients (85 %) had had at least one readmission. Full remission of global psychopathological symptoms [Clinical Global Impression (CGI) ≤ 2] was found in 3/39 (8 %),a moderate outcome (CGI=3–5) in 22/39 (56 %), and a poor outcome (CGI=6–8) was seen in 14/39 (36 %). Severe or very severe impairments of global social functioning [Global Assessment of Social Function (GAS)< 51] were observed in 20/39 (51 %). The best predictor of global psychopathological and psychosocial outcome was type of onset (CGI: Beta=0.36, GAS: Beta=–0.37). A poor outcome was seen in 22 out of 25 cases with insidious onset. All predictors together explained 58% of the variance in the Positive and Negative Syndrome (PANSS) negative symptom ratings at follow-up. Gender, duration of first inpatient treatment and duration of untreated psychosis were of no predictive value for outcome. The nature of the diagnosis in the first episode strongly predicted the diagnosis given for the whole course after 15 years. In 26/37 cases (70 %), diagnosis at onset and overall diagnoses were the same. Our finding of an incidence of 61% insidious onset is similar to that in adult onset schizophrenia (AOS), but different to very early onset schizophrenia (VEOS), which shows a higher rate of insidious onset, cognitive impairment and poor outcome. Therefore, it seems that VEOS is a special group compared with early onset schizophrenia (EOS) and AOS.
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References
Aarkrog T (1999) Psychotic adolescents 20–25 years later. Nordic J Psychiatry 53 (Suppl.):42
American Psychiatric Association. DSM IV (1994) Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC
Asarnow JR, Tompson MC, Goldstein MJ (1994) Childhood-onset schizophrenia: A follow-up study. Schizophr Bull 20:599–617
Crow TJ (1985) The two-syndrome concept: origins and current status. Schizophr Bull 11:471–486
Eaton WW, Motensen PB, Herrman H, Freeman H, Bilker W, Burgess P, Wooff K (1992) Long-term course of hospitalization for schizophrenia: Part I Risk for re-hospitalisation. Schizophr Bull 18:217–228
Eggers C (1973) Verlaufsweisen kindlicher und präpuberaler Schizophrenien. Monographie aus dem Gesamtgebiet der Psychiatrie Vol 4. Berlin, Germany, Springer-Verlag
Eggers C, Bunk D (1997) The long term course of childhood-onset schizophrenia: A 42-year follow up. Schizophr Bull 23:105–117
Eggers C, Bunk D, Krause D (2000) Schizophrenia with onset before the age of eleven. J Aut Develop Disord 30:29–38
Eggers C, Bunk D, Röpcke B (2002) Childhood and adolescent onset schizophrenia: Results from two long-term follow-up studies. Neurol Psychiat Brain Res 9:183–190
Gillberg IC, Hellgren L, Gillberg C (1993) Psychotic disorders diagnosed in adolescence. Outcome at age 30 Years. J Child Psychol Psychiatry 34:1173–1185
Gottesman II (1993) Schizophrenie. Spektrum Akademischer-Verlag, Heidelberg, Berlin, Oxford
Green WH, Padron-Gayol M, Hardesty AS, Bassiri M (1992) Schizophrenia with childhood onset: A phenomenological study of 38 cases. J Am Acad Child Adolesc Psychiatry 31:968–976
Gupta S, Rajaprabhakaran R, Arndt S, Flaum M, Andreasen NC (1995) Premorbid adjustment as a predictor phenomenological and neurobiological indices in schizophrenia. Schizophr Res 16:189–197
Häfner H, Riecher A, Maurer K, Meissner S, Schmidtke A, Fätkenheuer B, Löffler W, Heiden an der W (1990) Ein Instrument zur retrospektiven Einschätzung des Erkrankungsbeginns bei Schizophrenie (Instrument for the retrospective assessment of the onset of schizophrenia “IRAOS”). Entwicklung und erste Ergebnisse. Zeitschrift für klinische Psychologie und Psychotherapie 19:230–255
Häfner H, Nowotny B (1995) Epidemiology of early-onset schizophrenia. Eur Arch Psychiatry Clin Neurosci 245:80–92
Harding CM (1988) Course types in schizophrenia: An analysis of European and American studies. Schizophr Bull 14:633–643
Hegarty JD, Baldessarini RJ, Tohen M, Waternaux C, Oepen G (1994) One hundred years of schizophrenia: A metaanalysis of the outcome literature. Am J Psychiatry 151:1409–1415
Hollis C (2000) Adult outcomes of child- and adolescent-onset schizophrenia: Diagnostic stability and predictive validity. Am J Psychiatry 157:1652–1659
Huber G, Gross G, Schüttler R (1979) Schizophrenie.Verlaufs- und sozialpsychiatrische Langzeituntersuchungen an den 1945–1959 in Bonn hospitalisierten schizophrenen Kranken. Berlin, Germany, Springer-Verlag
Jung E, Krumm B, Biehl H, Maurer K, Bauer-Schubart C (1989) DAS-M: Mannheimer Skala zur Einschätzung sozialer Behinderung. Weinheim, Germany, Beltz-Verlag
Kay SR, Opler LA, Lindenmayer JP (1989) The Positive and Negative Syndrome Scale (PANSS): Rationale and standardisation. Br J Psychiatry 155 (Suppl 7):59–65
Kolvin I (1971) Studies in the childhood psychoses. Br J Psychiatry 118:381–395
Krausz M, Müller-Thomsen T (1993) Schizophrenia with onset in adolescence: an 11-year follow up. Schizophr Bull 19:831–841
Lay B, Blanz B, Hartmann M, Schmidt MH (2000) The psychosocial outcome of adolescent-onset schizophrenia: a 12-year follow up. Schizophr Bull 26:801–816
McClellan JM, Werry JS, Ham M (1993) A follow-up study of early onset psychosis: comparison between outcome diagnoses of schizophrenia, mood disorders, and personality disorders. J Aut Develop Disord 23:243–262
Pencer A, Addington J, Addington D (2005) Outcome of a first episode of psychosis in adolescence: a 2-year follow-up. Psychiatry Res 133:35–43
Schmidt M, Blanz B, Dippe A, Koppe T, Lay B (1995) Course of patients diagnosed as having schizophrenia during first episode occurring under age 18 years. Eur Arch Psychiatry Clin Neurosci 245:93–100
Werry JS (1992) Child and adolescent (early onset) schizophrenia: A review in light of DSM-III-R. J Aut Develop Disord 22:601–624
Werry JS, McClellan JM (1992) Predicting outcome in child and adolescent (early onset) schizophrenia and bipolar disorder. J Am Acad Child Adolesc Psychiatry 31:147–150
Wing JK, Cooper JE, Sartorius N (1974) The description and classification of psychiatric symptoms: An instruction manual for the PSE and CATEGO system. London, England, Cambridge University Press
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Röpcke, B., Eggers, C. Early-onset schizophrenia. Europ.Child & Adolescent Psych 14, 341–350 (2005). https://doi.org/10.1007/s00787-005-0483-6
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DOI: https://doi.org/10.1007/s00787-005-0483-6