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Schizophrenic Psychoses in Childhood and Adolescence

A Guide to Diagnosis and Drug Choice

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Summary

Psychotic disorders in childhood are rare conditions, although there are no reliable epidemiological data that could be looked upon as representative. This may be due to the fact that different investigators have used different definitions, and several heterogeneous disorders have been subsumed under the heading of ‘psychoses in childhood’. Nevertheless, it is assumed that only 0.1 to 1% of all schizophrenic psychoses manifest themselves before the age of 10 years; however, after the age of 13 years, a remarkable increase in the occurrence of schizophrenia can be observed.

The prognosis, course and outcome of the very early-onset psychoses, as well as the manifestation of the disorder in adolescence, seem to be less favourable as compared with adult-onset schizophrenia. The data so far available demonstrate that premorbid personality and adaptation, the occurrence or absence of developmental delays, age at onset, gradual or acute onset, impairment of cognitive functions, and the predominance of negative symptoms along with a high load of premorbid introverted symptomatology (e.g. shyness, social withdrawal, over-anxiousness) are of special relevance to the course and outcome of childhood schizophrenia.

Comparable with other fields of child psychopharmacology, the treatment of young patients with psychoses is characterised by a paucity of empirical studies evaluating the efficacy and safety of drug treatments. Despite the proven efficacy of conventional antipsychotics in the short term and maintenance treatment of schizophrenia, a high proportion (about 30 to 40%) of patients with early-onset and adolescent schizophrenia are initial nonresponders to this treatment. For these patients, a trial of atypical antipsychotics such as clozapine can be considered, if strict guidelines for clinical management are followed. In childhood and adolescence, the treatment of psychoses involves a multidimensional approach, including psychopharmacological therapy, psychotherapeutic modalities, family interventions and special rehabilitation measures.

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  1. Department of Child and Adolescent Psychiatry, Philipps University, Hans-Sachs-Str. 6, 35033, Marburg, Germany

    Helmut Remschmidt, Eberhard Schulz & Beate Herpertz-Dahlmann

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Remschmidt, H., Schulz, E. & Herpertz-Dahlmann, B. Schizophrenic Psychoses in Childhood and Adolescence. CNS Drugs 6, 100–112 (1996). https://doi.org/10.2165/00023210-199606020-00003

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