A Comparative Study of Clinical Correlates in Schizophrenia with Onset in Childhood, Adolescence and Adulthood

Abstract

Background: Childhood onset schizophrenia (COS) is a rare disorder. Comparative data on the effect of differential age of onset on clinical profile in schizophrenia are very few. Method: Subjects with COS (n=15), adolescence onset schizophrenia (AdOS, n=20) and adulthood onset schizophrenia (AOS, n=20) were compared on socio-demographic, clinical and genetic history parameters using Instrument for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS), Positive and Negative Symptoms Scale (PANSS), Family Instrument for Genetic Studies (FIGS), Wechsler’s Adult Intelligence Scale-Revised (WAIS-R), Malin’s Intelligence Scale for Indian Children (MISIC) and WHO Life Chart Schedule (WHO LCS). Results: Significantly higher rate of socioeconomic dependence, poorer academic performance, and nonparanoid subtype was seen in the COS group as compared to the AdOS and AOS. The total score on PANSS was maximum in the COS group with AdOS taking an intermediate position. COS patients had more somatic and obsessive symptoms whereas, AdOS patients had more selfinjurious behaviour and suicidal attempts. The response to typical antipsychotic medication was poorer in the COS group as compared to the other two groups. In spite of treatment with atypical antipsychotics (including clozapine), 1/3 rd of the COS patients continued to show limited response. The COS group scored least on the Mean IQ. The outcome was significantly poorer in patients of COS (33%), and it correlated significantly with low IQ. Conclusions: COS seems to be a more severe form of the schizophrenic illness with high degree of socioeconomic dependence, poorer response to treatment, greater and more florid psychopathology, poorer course and outcome, greater neurocognitive deficits and qualitative differences in the type of schizophrenia and non-specific symptom profile as compared to the later onset schizophrenias.