[Schizophrenia in childhood and adolescence. Symptomatology, clinical course, etiological and therapeutic aspects].

Schizophrenic psychosis is rare in patients below 15 years of age. Early diagnosis is crucial as the illness is likely to have a poor outcome: indeed, duration of untreated psychosis may exert a negative influence on the prognosis. Thus, it may be highly relevant to recognise premorbid changes of character traits, behaviour and cognitive problems which are reflected in worsening school performance. For example, some 40 to 50% of the children who later develop a psychosis will show social withdrawal, loss of interest in age-appropriate activities, peculiar or immature responsiveness, increasingly suspicious, fearful or depressive states, baseless despair, unusual somatic complaints, concentration problems, cognitive and linguistic disabilities, and peculiar motor movement disorders such as bizarre, ritualistic behaviour, mannerisms, stereotypies, echopraxia. These features are non-specific: they can but need not represent the early signs indicating later development of schizophrenia. They should be evaluated in terms of potential psychosocial, genetic and somatic pre-, peri- and postnatal risk categories. During the child's development these features may build up to constitute vulnerability and stress factors that may lead to psychotic breakdown. Early age of onset correlates with high social disability scores. Complete remission is an extremely rare event in patients with gradual-insidious onset of psychosis.