Clinique de l’enfance d’une population d’adultes schizophrènes. Étude rétrospective à propos de 50 cas

Abstract

ObjectivesThe early stages of schizophrenia have been particularly investigated in Northern Europe and in the English-speaking countries, aiming at creating screening programs, in order to improve the disease prognosis. Due to a lack of specificity, knowledge about the early manifestations of schizophrenia must be supported to implement effective prevention strategies. Our retrospective study aims at describing, in a dimensional approach, childhood symptoms of an adult schizophrenic population. MethodsThe sample consists of 50 schizophrenic adults, diagnosed with ICD-10 criteria, aged from 18 to 30, treated in the Psychotherapeutic Center of Nancy (CPN) in 2008 and previously in a child psychiatric department within the CPN. Various symptoms were collected from children psychiatric records using a dimensional reading grid created by the authors. Childhood and adolescence were dichotomized using the limit of 12years old. Continuity between the dimensions of childhood and adolescence was researched. ResultsOur sample consists of 72% male patients and includes a majority of early schizophrenia forms. The diagnosis was established in average around 21. Symptoms have been described in their medical records for 31 subjects during childhood and for 46 during adolescence. In our sample, the childhood semiology is characterized by six clinical dimensions (each with several signs): functional, cognitive, impulsivity, negative, anxiety and positive/dissociation. During their childhood, 25 patients had symptoms from more than two dimensions concurrently. The most frequent items belong to the functional dimension, which is not specific; but also, in 40% of cases, to the cognitive dimension. These symptoms correspond to the vulnerability markers of the premorbid stage of schizophrenia. In addition, eight patients were followed during their childhood for pervasive developmental disorders classified as « other » in ICD-10 (F 84.9). These disorders also seem to belong to premorbid manifestations, showing increased vulnerability to adult schizophrenia. Every childhood dimensions are stable through adolescence in our population with more statistical power for the items of impulsivity, anxiety and positive/dissociation dimensions. This result may suggest the existence of an evolutionary dimensional continuum, from childhood to adolescence in our population. ConclusionThe continuum highlighted by our study enables to show the emergence of various dimensions at different stages of the development of future schizophrenic patients. Other studies seem to be necessary to confirm our results. Although the described symptoms lack of specificity up to now, their presence can inform the therapist about the risk of later schizophrenia development.