Remschmidt H, Martin M, Fleischhaker C, Theisen F M, Hennighausen K, Gutenbrunner C, Schulz E
Department of Child and Adolescent Psychiatry, Philipps-University Marburg, Marburg, Germany.
J Neural Transm (Vienna). 2007;114(4):505-12. doi: 10.1007/s00702-006-0553-z. Epub 2006 Aug 10.
This paper describes the long-term course of 76 patients who had been consecutively admitted to the Department of Child and Adolescent Psychiatry, Philipps University, between 1920 and 1961 with a suspected diagnosis of childhood-onset schizophrenia. By means of a consensus analysis of available data in accordance with ICD-10 criteria, the diagnosis of schizophrenia was confirmed in only 50% of the original sample (n = 38, childhood-onset schizophrenia group); whereas the rest of the sample were allotted other diagnoses (n = 38, non-schizophrenia group). A follow-up investigation was conducted, interviewing all available patients, if possible, or their first-degree relatives or doctors. In the childhood-onset schizophrenia group, age at onset (mean +/- S.D.) was 12.7 +/- 2.5 (range 5-14) years and age at follow-up was 55.0 +/- 4.8 (range 42-62) years. The outcome of this group was poor. According to the Global Assessment Scale (GAS), only 16% had a good (GAS score 71-100) and 24% had a moderate (GAS score 41-70) outcome. In the 16 childhood-onset schizophrenia patients who could be personally investigated at follow-up, 10 (62.5%) displayed severe or moderate depressive symptoms according to the BPRS depressive score. The death rate (including suicide) was significantly higher in the schizophrenia group (n = 15; 39.5%) than in the non-schizophrenia group (n = 7; 18.4%). A comparison of the life-time diagnoses of the total sample (n = 76) at follow-up with the ICD-10 diagnoses made retrospectively revealed a diagnostic stability in 69 (91%) and a change of diagnosis in 7 (9%) cases, among them 4 who were originally diagnosed as having childhood-onset schizophrenia.
本文描述了1920年至1961年间连续入住菲利普斯大学儿童与青少年精神病学系、疑似诊断为儿童期起病精神分裂症的76例患者的长期病程。通过根据ICD - 10标准对现有数据进行共识分析，仅在原样本的50%（n = 38，儿童期起病精神分裂症组）中确诊为精神分裂症；而其余样本被分配了其他诊断（n = 38，非精神分裂症组）。进行了一项随访调查，尽可能采访了所有可找到的患者、他们的一级亲属或医生。在儿童期起病精神分裂症组中，起病年龄（均值±标准差）为12.7±2.5（范围5 - 14）岁，随访时年龄为55.0±4.8（范围42 - 62）岁。该组预后较差。根据总体评定量表（GAS），只有16%的患者预后良好（GAS评分71 - 100），24%的患者预后中等（GAS评分41 - 70）。在随访时能够接受个人调查的16例儿童期起病精神分裂症患者中，根据简明精神病评定量表（BPRS）抑郁评分，10例（62.5%）表现出重度或中度抑郁症状。精神分裂症组的死亡率（包括自杀）（n = 15；39.5%）显著高于非精神分裂症组（n = 7；18.4%）。将随访时总样本（n = 76）的终生诊断与回顾性做出的ICD - 10诊断进行比较，发现69例（91%）诊断稳定，7例（9%）诊断发生变化，其中4例最初被诊断为儿童期起病精神分裂症。
