CHILDHOOD-ONSET SCHIZOPHRENIA - PROGRESSIVE VENTRICULAR CHANGE DURINGADOLESCENCE

Background: There is controversy about progression in brain abnormalit ies in later-onset schizophrenia. This study looked for more striking progression in brain abnormalities during adolescence in a chronically ill, treatment-refractory sample of patients with childhood-onset sch izophrenia who had had more prepsychotic developmental disturbance, bu t clinical and neurobiological characteristics similar to those of pat ients with treatment-refractory adult-onset schizophrenia who have poo r outcome. Methods: Anatomic brain magnetic resonance images were obta ined for 16 children and adolescents with onset of schizophrenia by 12 years of age and 24 temporally yoked, age-and sex-matched healthy con trols. Subjects were scanned on initial admission and rescanned after 2 years with the identical equipment and measurement methods. Results: Childhood schizophrenics showed a significantly greater increase in v entricular volume than did controls, for whom ventricles did not incre ase significantly (analysis of variance, diagnosis x time, F = 16.1, P < .001). A significant decrease in midsagittal thalamic area was also seen for the schizophrenics (P = .03), which was unchanged at rescan for controls. These differential brain changes correlated significantl y with each other and tended to be predicted by both prepsychotic deve lopmental abnormality (Premorbid Assessment Scale, P = .06) and Brief Psychiatric Rating Scale at follow-up (P = .07). Conclusions: More con sistent progressive ventricular enlargement was seen during adolescenc e for this childhood-onset sample than has been reported for adult-ons et populations. The brain imaging results support other clinical data showing both early and late deviations in brain development for at lea st this rare subgroup of treatment-refractory, very-early-onset schizo phrenic patients.