Childhood-onset schizophrenia is a rare, clinically severe
form of schizophrenia, which is
associated with disrupted cognitive, linguistic, and social development
well before the
appearance of frank psychotic symptoms. This disruption of multiple developmental
domains signals the important opportunity these patients present for examining
neurodevelopmental and other etiologic hypotheses of schizophrenia. The
present research update
reviews studies of the phenomenology and neurobiology of childhood-onset
schizophrenia
conducted since 1994. Findings from these studies indicate that children
can be diagnosed
with schizophrenia using unmodified DSM-III, -IIIR, and -IV criteria, and
that the atypical
neuroleptic clozapine is an effective medication for this treatment refractory
group.
Neuropsychologic and neurobiologic studies generally support continuity
with adult-onset
schizophrenia, with evidence of more severe premorbid impairment. Longitudinal
studies
show preliminary evidence of progressive ventricular enlargment and more
prolonged
deterioration in intellectual function than is seen in the adult-onset
disorder. If replicated,
these observations, together with the insidious onset of this disorder,
would suggest that the
pathologic underpinning of childhood-onset schizophrenia is not a single
static lesion or
event but may be a continuous or multi-event process.