Nicolson R, Lenane M, Brookner F, Gochman P, Kumra S, Spechler L, Giedd J N, Thaker G K, Wudarsky M, Rapoport J L
Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892-1600, USA.
Compr Psychiatry. 2001 Jul-Aug;42(4):319-25. doi: 10.1053/comp.2001.24573.
Although psychotic phenomena in children with disruptive behavior disorders are more common than expected, their prognostic significance is unknown. To examine the outcome of pediatric patients with atypical psychoses, a group of 26 patients with transient psychotic symptoms were evaluated with clinical and structured interviews at the time of initial contact (mean age, 11.6 +/- 2.7 years) and at follow-up 2 to 8 years later. Measures of functioning and psychopathology were also completed at their initial assessment. Risk factors associated with adult psychotic disorders (familial psychopathology, eyetracking dysfunction in patients and their relatives, obstetrical complications, and premorbid developmental course in the proband) had been obtained at study entry. On follow-up examination (mean age, 15.7 +/- 3.4 years), 13 patients (50%) met diagnostic criteria for a major axis I disorder: three for schizoaffective disorder, four for bipolar disorder, and six for major depressive disorder. The remaining 13 patients again received a diagnosis of psychotic disorder not otherwise specified (NOS), with most being in remission from their psychotic symptoms. Among this group who had not developed a mood or psychotic disorder, disruptive behavior disorders were exceedingly common at follow-up and were the focus of their treatment. Higher initial levels of psychopathology, lower cognitive abilities, and more developmental motor abnormalities were found in patients with a poor outcome. Obstetrical, educational, and family histories did not differ significantly between the groups. Through systematic diagnostic evaluation, children and adolescents with atypical psychotic disorders can be distinguished from those with schizophrenia, a difference with important treatment and prognostic implications. Further research is needed to delineate the course and outcome of childhood-onset atypical psychoses, but preliminary data indicate improvement in psychotic symptoms in the majority of patients and the development of chronic mood disorders in a substantial subgroup.
尽管破坏性行为障碍儿童中的精神病性现象比预期更为常见，但其预后意义尚不清楚。为了研究患有非典型精神病的儿科患者的结局，一组26例有短暂精神病性症状的患者在初次接触时（平均年龄11.6±2.7岁）以及2至8年后的随访时接受了临床和结构化访谈。在初次评估时还完成了功能和精神病理学测量。在研究开始时已获取了与成人精神病性障碍相关的危险因素（家族性精神病理学、患者及其亲属的眼动追踪功能障碍、产科并发症以及先证者病前发育过程）。在随访检查时（平均年龄15.7±3.4岁），13例患者（50%）符合轴I主要障碍的诊断标准：3例为精神分裂情感性障碍，4例为双相情感障碍，6例为重度抑郁症。其余13例患者再次被诊断为未另行特指的精神病性障碍（NOS），大多数患者的精神病性症状已缓解。在这组未患情绪或精神病性障碍的患者中，破坏性行为障碍在随访时极为常见，且是其治疗的重点。结局较差的患者初始精神病理学水平较高、认知能力较低且发育性运动异常较多。两组之间的产科、教育和家族史无显著差异。通过系统的诊断评估，患有非典型精神病性障碍的儿童和青少年可与精神分裂症患者区分开来，这一差异具有重要的治疗和预后意义。需要进一步研究来描述儿童期起病的非典型精神病的病程和结局，但初步数据表明大多数患者的精神病性症状有所改善，且相当一部分亚组患者会发展为慢性情绪障碍。
