Early-onset schizophrenia

Abstract

Abstract Schizophrenic psychoses in childhood are important but rare disorders within the spectrum of the psychoses. Since the descriptions of Homburger (1926) and Lutz (1937/38), there is no doubt about the existence of schizophrenic psychoses in childhood. According to Bleuler (1911) and Lutz (1937/38) about 4% of schizophrenic psychoses begin before the 15th year of life, and 0.5% to 1%, before the 10th year. There is a remarkable increase in frequency during adolescence, and with increasing age the symptomatology becomes quite similar to that of adult patients. Accordingly, the classification is much easier during adolescence than during childhood. It is not clear if the criteria of the current classification systems (International Classification of Disease, 10th ed. [ICD-10] and the Diagnostic and Statistical Manual of Mental Disease, 4th ed. [DSM-IV]) are appropriate for schizophrenic disorders in younger children, e.g., below the age of 10 or 12 years. Many of these children suffer from other early developmental, cognitive, and/or emotional disorders, thus complicating an adequate classification within a system that was primarily constructed for the adult type of schizophrenia. It may be that there are two types of childhood and adolescent schizophrenia: one type that can clearly be diagnosed using the prototype of adult symptomatology without remarkable developmental precursors, and another one complicated by an additional and complex developmental disorder that may modify the expression of symptoms in an ageand stage-appropriate way. For practical purposes, the current classification systems can be used, but we should always be aware that they reflect our current knowledge and do not describe clear-cut nosological entities.