Schizophrenia in Children and Adolescents

322 Pages·2000·2.25 MB·English

by  Helmut Remschmidt

Schizophreniainchildrenandadolescents
The earlier in life schizophrenia manifests itself, the poorer the long-term prognosis, and
althoughitisverydifficulttodiagnoseintheyoung,earlytreatmentisnowthoughttoimprove
outcome. Recent research also suggests that early onset schizophrenia has developmental
precursors,makingitdifficulttodistinguishfromanumberofotherdevelopmentaldisorders.In
thistimelybook,aninternationalteamofpsychiatrists,psychotherapistsandpsychologistsgive
an up-to-datereviewof the latest findingsin the diagnosisand treatmentofschizophreniain
childrenandadolescentstogiveacomprehensiveaccountofthecurrentstateofknowledgeand
thetherapeuticoptionsavailabletoclinicians.Theyexaminethedisorderfromdevelopmental
andclinicalperspectives,withafocusondiagnosis,etiology,therapy,andrehabilitation.This
book is essential reading for all mental health professionals who treat young people with
schizophrenia.
HelmutRemschmidtisProfessorofChildPsychiatryandHeadoftheDepartmentofChildand
AdolescentPsychiatryatPhilippsUniversityinMarburg.Hehaspublishedwidelyinthefieldof
child and adolescent psychiatry, with particular interest in developmental psychopathology,
schizophreniaresearch,psychiatricgenetics,therapy,andevaluationresearch.
CambridgeChildandAdolescentPsychiatry
Childandadolescentpsychiatryisanimportantandgrowingareaofclinicalpsychiatry.Thelastdecade
hasseenarapidexpansionofscientificknowledgeinthisfieldandhasprovidedanewunderstandingof
theunderlyingpathologyofmentaldisordersintheseagegroups.Thisseriesisaimedatpractitioners
and researchers both in child and adolescent mental health services and developmental and clinical
neuroscience.Focusingonpsychopathology,ithighlightsthosetopicswherethegrowthofknowledge
has had the greatest impact on clinical practiceand on the treatment and understandingof mental
illness. Individual volumes benefit both from the international expertise of their contributors and a
coherencegeneratedthroughauniformstyleandstructurefortheseries.Eachvolumeprovidesfirstly
anhistoricaloverviewandacleardescriptiveaccountofthepsychopathologyofaspecificdisorderor
group of related disorders. These featuresthen form the basis for a thoroughcritical review of the
etiology,naturalhistory,management,preventionandimpactonlateradultadjustment.Whilsteach
volumeisthereforecompleteinitsownright,volumesalsorelatetoeachothertocreateaflexibleand
collectableseriesthatshouldappealtostudentsaswellasexperiencedscientistsandpractitioners.
Editorialboard
Serieseditor ProfessorIanM.Goodyer UniversityofCambridge
Associateeditors
ProfessorDonaldJ.Cohen ProfessorRobertN.Goodman
YaleChildStudyCenter InstituteofPsychiatry,London
ProfessorBarryNurcombe ProfessorHelmutRemschmidt
TheUniversityofQueensland KlinikumderPhilipps-Universita¨t,Germany
ProfessorHermanvanEngeland ProfessorFredR.Volkmar
AcademischZiekenhuisUtrecht YaleChildStudyCenter
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Schizophrenia
in children and
adolescents
Editedby
Helmut Remschmidt
publishedbythepresssyndicateoftheuniversityofcambridge
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©CambridgeUniversityPress2001
Thisbookisincopyright.Subjecttostatutoryexception
andtotheprovisionsofrelevantcollectivelicensingagreements,
noreproductionofanypartmaytakeplacewithout
thewrittenpermissionofCambridgeUniversityPress.
Firstpublished2001
PrintedintheUnitedKingdomattheUniversityPress,Cambridge
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LibraryofCongressCataloguinginPublicationdata
ISBN0521794285paperback
Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup-to-dateinformationwhichis
inaccordwithacceptedstandardsandpracticeatthetimeofpublication.Nevertheless,theauthors,editors
andpublishercanmakenowarrantiesthattheinformationcontainedhereinistotallyfreefromerror,not
leastbecauseclinicalstandardsareconstantlychangingthroughresearchandregulation.Theauthors,
editorsandpublisherthereforedisclaimallliabilityfordirectorconsequentialdamagesresultingfromthe
useofmaterialcontainedinthisbook.Readersarestronglyadvisedtopaycarefulattentiontoinformation
providedbythemanufacturerofanydrugsorequipmentthattheyplantouse.
Thisbookisdedicatedtothememoryof
WilliamLl.Parry-JonesandMichaelGoldstein.
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Contents
Listofcontributors pagexi
Preface xiii
1 Childhoodpsychosisandschizophrenia:ahistoricalreview 1
ThelateWilliamLl.Parry-Jones
Introduction 1
Historiographyofschizophrenia 1
Psychoticjuvenilesinasylums 11
Premorbidcharacteristicsandborderlinedisorder 12
Epidemiology 12
Theoriesofcausation 13
Treatmentandoutcome 14
Conclusions 16
References 17
2 Definitionandclassification 24
HelmutRemschmidt
Introduction 24
Earlydescriptions 24
Generalcriteriafortheclassificationofpsychoticdisordersinchildren
andadolescents 26
Psychoticdisordersinchildhoodandadolescenceandtheirrelationto
schizophrenia 28
Theconceptofpositiveandnegativeschizophreniainchildrenand
adolescents 30
Premorbidcharacteristics 32
ClassificationaccordingtoICD-10 33
ClassificationaccordingtoDSM-IV 37
Conclusions 39
References 39
vii
viii Contents
3 Epidemiologyofearlyonsetschizophrenia 43
ChristopherGillberg
Introduction 43
Childhoodautism 44
Aspergersyndrome 44
DisintegrativedisorderandRettsyndromevariants 46
Landau–Kleffnersyndromeandthesyndromeofelectricalstatus
epilepticusduringsleep 46
Veryearlyonsetschizophrenia(12yearsorunder) 47
Adolescentonsetschizophrenia(13–19yearsofage) 51
Conclusions 54
References 54
4 Childhoodschizophrenia:developmentalaspects 60
FredR.Volkmar
Introduction 60
Clinicalfeaturesofchildhoodonsetschizophrenia 63
Developmentalissuesindifferentialdiagnosis 73
Summaryanddirectionsforfurtherresearch 74
References 75
5 Diagnosisanddifferentialdiagnosis 82
ChrisHollis
Introduction 82
Historicalbackground:anevolvingdiagnosticconstruct 84
Recentconceptualdevelopments 86
Principlesofclinicalepidemiology:toolstoestimatetheusefulnessof
diagnosticcriteria 88
Diagnosticcriteria:DSM-IVandICD-10 91
Assessment:thepursuitofreliability 94
Diagnosticvalidity 97
Developmentalvariability:symptomsandassociatedfeatures 100
Theinfluenceofageandcognitiononsymptomassessment 101
Aretherecontinuitiesbetweenpremorbiddevelopmentalimpairments
andpsychoticsymptoms? 103
Differentialdiagnosis 103
IstherecontinuitybetweentheMDIsyndromeandschizophrenia? 105
Thedifferentialdiagnosisofpsychoticsymptomsinchildrenand
adolescents 106
ix Contents
Differentialdiagnoses 107
Preventionanddetectionof‘atrisk’orprodromalstates 109
Conclusions 112
References 113
6 Geneticaspects 119
JaneScour(cid:222)eldandPeterMcGuf(cid:222)n
Introduction 119
Definingthephenotype 119
Markersofvulnerabilityandchildhoodprecursors 120
Geneticepidemiology 121
Typeofinheritance 127
Moleculargenetics 127
Conclusions 131
References 131
7 Neurobehavioralperspective 135
RobertF.AsarnowandCananKaratekin
Introduction 135
Precursorsofpsychoticsymptomsinschizophrenicchildren 136
Studiesofcognitive/neuropsychologicalfunctioning 139
Linkofcognitiveimpairmenttoformalthoughtdisorder(FTD)and
discourseskills 151
Studiesofevent-relatedpotentials(ERPs) 153
Neurobiology 156
Neurodevelopmentalmodel 159
References 161
8 Psychosocialfactors:thesocialcontextofchildandadolescentonset
schizophrenia 168
JoanR.Asarnow,MarthaC.TompsonandthelateMichaelJ.Goldstein
Introduction 168
Schizophreniainadolescence:psychosocialfunctioningand
developmentalprogressions 168
Follow-upstudies 169
Premorbidadjustmentandpredictorsofoutcome 170
Familystress 171
Treatmentstrategiesforschizophreniainadolescents 173
Thepsychosocialtreatmentofadolescentswithschizophrenia 181
x Contents
Importanceofearlyintervention 183
Conclusions 186
References 187
9 Treatmentandrehabilitation 192
HelmutRemschmidt,MatthiasMartin,KlausHennighausenandEberhardSchulz
Neuroleptic(antipsychotic)agentsandtheirproperties 192
Electroconvulsivetreatment(ECT) 228
Psychotherapeuticmeasures(seealsoChapter8) 232
Familyorientedmeasures(seealsoChapter8) 240
Specificmeasuresofrehabilitation 244
Acomprehensivetreatmentandrehabilitationprogram 252
References 256
10 Courseandprognosis 268
SallyNicolaMerryandJohnScottWerry
Introduction 268
Selectionofstudies 272
Organizationofthereview 273
Premorbidadjustment 276
Onset 277
Course 280
Outcome 282
Factorsaffectingoutcome 287
Summaryandconclusions 293
References 294
Index 298
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