Symptom dimensions in the course of childhood-onset schizophrenia

The symptom dimensions of childhood-onset schizophrenia (COS) are described by focussing on the clinical features of 44 patients at onset of illness d uring the first episode and at follow-up investigation 42 years after onset . All subjects were re-diagnosed according to DSM IV. The symptomatology wa s evaluated with the Positive and Negative Symptom Scale (PANSS) at onset a nd at follow-up. Two principal component factor analyses with varimax-rotat ion were applied to the complete items set of the PANSS. The frequencies of positive, negative, and global symptoms were compared longitudinally in an ANOVA-repeated measures design. The factor analysis revealed 5 orthogonal symptom dimensions (factors) at onset of psychosis: Cognition, social withd rawal, antisocial behaviour, excitement, and reality distortion. At follow- up a five-factor solution was found, too, but different dimensions emerged: a positive, negative, excitement, cognitive, and anxiety/depression compon ent which fits to the 5-factor model of White et al. (1997). The first psyc hotic episode of EOS is accompanied with more unspecific symptoms such as s ocial withdrawal and antisocial behavior. In the later stages of (COS) the structure of symptom dimensions changes to that known from adult-onset schi zophrenia (AOS). The results indicate that COS and AOS are comparable nosol ogical entities and that more than 3 dimensions are required to describe th e relevant clinical symptom structure. Positive and global symptoms decreas ed significantly during the course of illness. The frequencies of negative symptoms did not change which demonstrates their disabling impact.