Schizophrenia with onset before the age of eleven: Clinical characteristics of onset and course

This study reports on the long-term course of 11 patients (6 girls, 5 boys) with childhood onset schizophrenia (COS, age at onset < 10 years). Patient s were examined twice (mean follow-up period 38 years after onset). The pre morbid development is assessed in terms of the Modified Premorbid Adjustmen t Scale (M- PAS) and additionally described by distinct psychopathological categories. The psychopathology at the onset of psychosis and at the second follow-up examination was assessed by categorical application of the Posit ive and Negative Syndrome Scale (PANSS). The outcome was rated with the Dis ability Assessment Score (DAS). The course of psychotic episodes and interv als between them is presented according to DSM-IV subtype classifications. Ten of Ii patients presented premorbid developmental peculiarities that wer e not adequately covered by the M-PAS subscales. Whereas in the 4 patients with acute onset of psychosis the positive PANSS-type was predominant, in t he 7 patients with an insidious onset the negative PANSS-type prevailed. Th e nature of the diagnostic subtypes varied markedly across the course of th e illness. In case of a continuous predominant catatonic symptomatology the outcome was poor. Detailed case descriptions help to illuminate the hetero geneous psychopathology of COS. Various temporary premorbid behavioral pecu liarities were precursors of COS. A differentiation between premorbid and p rodromal signs proved to be arbitrary. Our results contradict the assumptio n that COS is characterized only by a negative symptomatology.