Abstract :
Since 1900, a unique study of the phenomenology and neurobiology of very early onset schizophrenia has been ongoing at the NIMH. A total of 28 children and adolescents meeting DSM III-R criteria for schizophrenia, with onset of psychosis before age 12 have participated in this inpatient study. Clinically, the diagnosis of schizophrenia is greatly overused. A large group of “false positives”, termed “multidimensionally impaired” by our group have transient hallucinations under stress in a background of early language disturbance, affective liability and disruptive behavior. Patients meeting full criteria for schizophrenia (mean age 14.1 yrs) resemble poor outcome adult cases in the insidious onset, and severe symptomatic impairment. Surprisingly, males and females are equally represented, and have a virtually identical age of onset (10.2 and 10.3 yrs respectively). Developmentally, males had an excess of motor and speech delays premorbidly, however there was also some excess of these problems for females. Three children had a first degree relative with schizophrenia, possibly reflecting referral bias. Neurobiological measures including eye tracking anatomic MRI were consistent in indicating continuity with later onset disorder. One of twenty-five full siblings was autistic, while two were mentally retarded suggesting a vulnerability in these families to CNS maldevelopment.
