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Early-onset Schizophrenia is defined by an onset prior to adulthood, with an onset prior to 12 years of age being rare (Vyas et al., 2011). The Diagnostic and Statistical Manual of Mental Disorders <\/em>(5^{th<\/sup> ed.; DSM-5; American Psychiatric Association, 2013) identifies early onset as being associated with a worse prognosis. The DSM-5 further emphasizes that childhood schizophrenia is more difficult to diagnosis, where as compared to adults, \u201cchildhood delusions and hallucinations may be less elaborate\u201d (p. 102), and visual hallucinations should be \u201cdistinguished from normal fantasy play\u201d (p. 102). \u00a0Furthermore, hallucinations are not uncommon in both healthy children and children with a psychiatric illness, yet often with childhood schizophrenia, hallucinations are multimodal (Driver, Gogtay, & Rapoport, 2013). Diagnostic criteria for schizophrenia are \u201cage independent\u201d (Stentebjerg-Olesen, Pagsberg, Fink-Jensen, Correll, & Jeppesen, 2016), which is supported by diagnostic stability throughout the lifespan.<\/p>\n}

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Yet there is still ambiguity with differential diagnosis for early-onset schizophrenia. \u00a0As noted by Stentebjerg-Olesen, Pagsberg, Fink-Jensen, Correll, and Jeppesen (2016) there is \u201cconsiderable overlap in phenomenology between schizophrenia and affective symptomatology in children and adolescents with psychosis\u201d (p. 411).\u00a0 As cited in Stentebjerg-Olesen et al. (2016), Weary (1992) and Masi et al. (2006) the most common diagnostic mistake is a \u201cmisclassification of a mood disorder as schizophrenia\u201d (p. 411).\u00a0 Other diagnostic considerations extend to pervasive developmental disorders, severe personality disorders or traits, posttraumatic stress disorder (PTSD), generalized anxiety disorder, and obsessive-compulsive disorder (Driver et al., 2013). \u00a0As such understanding the \u201cdevelopmentally sensitive descriptions of symptomatology, clinical characteristics, and outcome\u201d may offer a clearer diagnostic picture for early-onset schizophrenia (Stentebjerg-Olesen et al., 2016, p. 411).<\/p>\n

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In a systematic review of studies from 1990 to 2014 of early-onset psychosis, Stentebjerg-Olesen et al. (2016) found that hallucinations were mainly auditory (81.9%) and delusions were mostly persecutory and of reference (77.5%). Formal thought disorder was found in 65% of the patients and 36% had disorganized speech or pressured speech.\u00a0 Negative symptoms were found in about half of the patients, and half of the group with negative symptoms experienced positive symptoms as well.\u00a0 Comorbidity was high at 32% for substance abuse and 33.5% for ADHD and disruptive behavioral disorders.\u00a0 Trauma is also thought to play a significant role in early-onset schizophrenia, with Stentebjerg-Olesen et al. (2016) finding a high level of comorbid PTSD (34%).<\/p>\n

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Stentebjerg-Olesen et al. (2016) found that \u201cseverity of positive symptoms at baseline, the severity and the persistence of negative symptoms, longer [duration of untreated psychosis], and poorer premorbid adjustment each predicted a worse outcome of illness\u201d (p. 423).\u00a0 Longer duration of untreated psychosis and poorer premorbid adjustment were also associated with poorer outcomes. In short, patients with early-onset schizophrenia were found to have substantial impairment from positive and negative symptoms, disorganized behavior, and pre- and comorbid conditions and diagnoses.\u00a0 The authors note that the \u201chigh prevalence of negative and disorganized\u201d symptoms \u201cmay mask the emergence of psychosis\u201d and delay identification and treatment (p. 424).<\/p>\n

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Dannie S. Harris
\nWKPIC Doctoral Intern<\/p>\n

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References
\nAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders <\/em>(5^{th<\/sup> ed.). Washington, DC: Author.<\/p>\n}

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Driver, D. I., Gogtay, N., & Rapoport, J. L. (2013). Childhood onset schizophrenia and early onset schizophrenia spectrum disorders.\u00a0 Child and Adolescent Psychiatric Clinics of North America, 22<\/em>(4), 539-555. \u00a0<\/em><\/p>\n

Stentebjerg-Olesen, M., Pagsberg, A. K., Fink-Jensen, A., Correll, C. U., & Jeppesen, P. (2016). Clinical characteristics and predictors of outcome of schizophrenia-spectrum psychosis in children and adolescents: A systematic review. Journal of Child and Adolescent Psychopharmacology, 26<\/em>(5), 410-427.<\/p>\n

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Vyas, N. S., Patel, N. H., & Puri, B. K. (2011). Neurobiology and phenotypic expression in early onset schizophrenia. Early Intervention in Psychiatry, 5, <\/em>3-14.<\/p>\n

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