Course of patients diagnosed as having schizophrenia during first episode occurring under age 18 years

  • Martin Schmidt
  • Bernd Blanz
  • Astrid Dippe
  • Till Koppe
  • Barbara Lay


Of 118 child and adolescent schizophrenic patients (ICD-9: 295.x; mean onset age 16.0 years), 97 (82.2%) could be completely investigated at follow-up (mean interval 7.4 years; mean age 23.1 years). At followup 30% of the patients were semidependent or dependent, 72% still required psychiatric treatment, 44% were at least moderately impaired with regard to educational/occupational functions and 58% with regard to social functions; 73% had experienced at least one further schizophrenic episode. Comparison with schizophrenia beginning in adulthood showed that the impairment in social function was much greater in the younger group of patients. These results support the belief that schizophrenic psychoses starting in adolescence have a worse outcome than those beginning in adulthood. The most efficient indicators for a worse outcome were long duration of inpatient treatment at first admission, a high number of symptoms and low social competence at discharge.


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  1. Andreasen NC, Olsen S (1982) Negative versus positive schizophrenia. Definition and validation. Arch Gen Psychiatry 39: 789–794Google Scholar
  2. Annesley PT (1961) Psychiatric illness in adolescence: Presentation and prognosis. J Ment Sci 106:268–278Google Scholar
  3. Biehl H, Maurer K, Jung E, Krumm B, Schubart C (1987) Zum “natürlichen Verlauf” schizophrener Erkrankungen-Begriff und Beispiele zum beobachteten Verhalten in einer prospektiven Studie. Nervenheilkunde 6:153–163Google Scholar
  4. Blanz B, Dippe A, Koppe T, Lay B, Schmidt MH (1989) MIS-ABE-Mannheimer Interview zur Erfassung des Schul-, Ausbildungs- und Berufsstatus junger Erwachsener (unpublished interview)Google Scholar
  5. Blanz B, Schmidt MH, Esser G (1991) Familial adversities and child psychiatric disorders. J Child Psychol Psychiatry 32, 6: 939–950Google Scholar
  6. Blanz B, Schmidt MH, Detzner U, Lay B (1994) Is there a sex-specific difference in onset age of schizophrenia that started before age 18? Eur J Child Adolesc Psychiatry 3:267–276Google Scholar
  7. Bleuler ME (1972) Die schizophrenen Geistesstörungen im Lichte langjähriger Kranken- und Familiengeschichten. Thieme, StuttgartGoogle Scholar
  8. Bleuler ME (1978) The long-term course of schizophrenic psychoses. In: Wynne LC, Cromwell RL, Matthyse S (eds) The nature of schizophrenia. Wiley, New YorkGoogle Scholar
  9. Carter AB (1942) (eds) Prognostic factors of adolescent psychoses. J Ment Sci 88:31–81Google Scholar
  10. Castle DJ, Murray RM (1991) Editorial: the neurodevelopmental basis of sex differences in schizophrenia. Psychol Med 21: 565–575Google Scholar
  11. Ciompi L, Müller C (1976) Lebensweg und Alter der Schizophrenen. Eine katamnestische Langzeitstudie bis ins Senium. Springer, Berlin Heidelberg New YorkGoogle Scholar
  12. Crow TJ (1985) The two-syndrome concept: origins and current status. Schizophr Bull 11:471–485Google Scholar
  13. Eggers C (1989) Schizo-affective psychosis in childhood: A follow-up study. J Autism Dev Disord 19:327–342Google Scholar
  14. Errera PA (1957) A sixteen-year follow-up of schizophrenic patients seen in an outpatient clinic. Arch Neurol Psychiatry 78: 84–87Google Scholar
  15. Foerster A, Lewis S, Owen M, Murray R (1991) Pre-morbid adjustment and personality in psychosis. Br J Psychiatry 158: 171–176Google Scholar
  16. Huber G, Gross G, Schüttler R (1979) Schizophrenie. Eine verlaufs- und sozialpsychiatrische Langzeitstudie. Springer, Berlin Heidelberg New YorkGoogle Scholar
  17. Jahn T, Mussgay L (1989) Die statistische Kontrolle möglicher Medikamenteneinflüsse in experimentalpsychologischen Schizophreniestudien: Ein Vorschlag zur Berechnung von Chlorpromazinäquivalenten. Z Klin Psychol 18, 3:257–267Google Scholar
  18. Johnstone EC, Owens DG, Gold A, et al (1984) Schizophrenic patients discharged from hospital: a follow-up study. Br J Psychiatry 145:586–590Google Scholar
  19. Johnstone EC, Crow TJ, Johnson AL, et al. (1986) The Northwick Park Study of first episodes of schizophrenia. I. Presentation of the illness and problems relating to admission. Br J Psychiatry 148:115–120Google Scholar
  20. Jung E, Krumm B, Biehl H, Maurer K, Bauer-Schubart C (1989) The Mannheim scale for the assessment of social disability. Beltz, WeinheimGoogle Scholar
  21. Leary J, Johnstone EC, Owens DG (1991) I. Background, method and general description of the sample. Br J Psychiatry 159 [Suppl 13]:7–12Google Scholar
  22. MacMillan JF, Crow TJ, Johnson AL, et al (1986) The Northwick Park Study of first episodes of schizophrenia. Br J Psychiatry 148:128–133Google Scholar
  23. Masterson JF (1956) Prognosis in adolescent disorders-schizophrenia. J Nerv Ment Dis 124:219–232Google Scholar
  24. Owens DG, Johnstone EC (1980) The disabilities of chronic schizophrenia — their nature and the factors contributing to their development. Br J Psychiatry 136:384–395Google Scholar
  25. Pearlson GD, Kim WS, Kubos KL, Moberg PJ, Jayaram G, Bascom MJ, Chase GA, Goldfinger AD, Tune LE (1989) Ventricle-brain ratio, computed tomographic density and brain area in 50 schizophrenics. Arch Gen Psychiatry 46:690–697Google Scholar
  26. Remschmidt H, Martin M, Schulz E, Gutenbrunner C, Fleischhaker C (1991) The concept of positive and negative schizophrenia in child and adolescent psychiatry. In: Marneros A, Andreasen NC, Tsuang MT (eds) Negative versus positive schizophrenia. Springer, Berlin Heidelberg New York, pp 219–242Google Scholar
  27. Stephens JH (1970) Long-term course and prognosis in schizophrenia. Semin Psychiatry 2:464–485Google Scholar
  28. Vaillant GE (1978) The distinction between prognosis and diagnosis in schizophrenia. In: Wynne LC, Cromwell RL, Matthyse S (eds) The nature of schizophrenia. Wiley, New YorkGoogle Scholar
  29. Walker EF, Harvey PD, Periman D (eds) (1988) The positive negative symptom distinction in psychoses. J Nerv Ment Dis 176: 359–363Google Scholar
  30. Warren WA (1965) A study of adolescent psychiatric in-patients and the outcome six or more years later. II: The follow-up study. J Child Psychol Psychiatry 6:141–160Google Scholar
  31. Watt DC, Katz K, Shepherd M (1983) Preliminary communication. The natural history of schizophrenia: a 5-year prospective follow-up of a representative sample of schizophrenics by means of a standardized clinical and social assessment. Psychol Med 13:663–670Google Scholar
  32. Weiner IB (1982) Child and adolescent psychopathology. Wiley, New YorkGoogle Scholar
  33. Werry JS (1992) Child and adolescent (early onset) schizophrenia: a review in the light of DSM-III-R. J Autism Dev Disord 22: 601–624Google Scholar
  34. Werry JS, McClellan JM, Chard L (1991) Childhood and adolescent schizophrenic, bipolar and schizoaffective disorders: a clinical and outcome study. J Am Acad Child Adolesc Psychiatry 30, 3:457–465Google Scholar
  35. Werry JS, McClellan JM (1992) Predicting outcome in child and adolescent (early onset) schizophrenia and bipolar disorder. J Am Acad Child Adolesc Psychiatry 31, 1:147–150Google Scholar
  36. Westermeyer JF, Harrow M (1988) Course and outcome in schizophrenia. In: Tsuang MT, Simpson JS (eds) Handbook of schizophrenia, vol 3: nosology, epidemiology and genetics. Elsevier, AmsterdamGoogle Scholar
  37. World Health Organization (1978) Mental disorders: glossary and guide to their classification in accordance with the ninth revision of the International Classification of Diseases. WHO, GenevaGoogle Scholar
  38. World Health Organization (1988) WHO Psychiatric Disability Assessment Scheduoe, WHO, GenevaGoogle Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • Martin Schmidt
    • 1
  • Bernd Blanz
    • 1
  • Astrid Dippe
    • 1
  • Till Koppe
    • 1
  • Barbara Lay
    • 1
  1. 1.Department of Child and Adolescent Psychiatry at the Central Institute of Mental HealthMannheimGermany

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