Sakaguchi M
Dep. of Psychiatry, Tokyo Metropolitan Matzuzawa Hospital.
Seishin Shinkeigaku Zasshi. 1991;93(5):309-33.
The concept of "childhood schizophrenia" is ambiguous because of problems on the diagnostic level, especially in regard to symptomatology and prognosis. After studies which produced the description of "early infantile autism", childhood schizophrenia studies were even more confused. One reason for this was that there were not sufficient follow-up studies about the schizophrenia-like psychoses during occurring childhood, on the one hand, and the retrospective-anamnestic research was limited in the field of adult psychiatry, on the other hand. The author has focused on two points of view in order to discuss the problem of childhood schizophrenia. One is the non outbreak of childhood psychoses in children from 6 to 8 years old which was demonstrated by a couple of epidemiological research studies. The other is the concept of "Knick" (in Germany) which usually accompanies classical German theories of schizophrenia. "Knick" means that, at some point in the patient's history, there is an incident that is the indication of the onset of schizophrenia. The subjects were selected from the author's own cases. They continuously and insidiously developed schizophrenic symptoms during pre-puberty and puberty, presenting behavioral abnormalities or neurosis-like signs from early childhood. The diagnostic criteria for schizophrenia corresponds to DSM-III and with the German theory of Bleuler and Schneider. All cases have been treated for more than ten years. The acute onset cases, the mentally retarded cases (DSM-III .318) and the cases with suspected organic brain disorders were excluded because of the diagnostic problems. The author could differentiate these subjects into three groups based on the development in the infantile stage. The first was autistic group and the second mentally subnormal (DSM-III .317) or borderline group. Psychiatric problems of these two groups were already obvious in early childhood. The third group developed normally until they were 3-5 years old. After that they presented neurotic symptoms having some kind of intra-familiar problems. The author could confirm that these three groups manifested various kinds of neurosis-like symptoms, mainly obsessive-compulsive ones, from 3-5 years old. The so-called latent time, which is thought to be a non-outbreak time of childhood psychoses, may correspond to the prodromal stage of schizophrenia in these cases. This research is based on study of 31 children. An in-depth study has been done by the author of 6 of these children, 2 in each of the 3 categories described above. The "Knick"-points were not identifiable in these cases.(ABSTRACT TRUNCATED AT 400 WORDS)
“儿童精神分裂症”这一概念因诊断层面的问题而模糊不清，尤其是在症状学和预后方面。在对“早期婴儿自闭症”进行描述的研究之后，儿童精神分裂症的研究变得更加混乱。一方面，对于儿童期出现的类精神分裂症性精神病，缺乏足够的随访研究；另一方面，回顾性记忆研究在成人精神病学领域也存在局限性。为了探讨儿童精神分裂症问题，作者聚焦于两个观点。一是一些流行病学研究表明6至8岁儿童中不存在儿童期精神病的爆发。另一个是“转折”（在德国）这一概念，它通常伴随着经典的德国精神分裂症理论。“转折”意味着在患者病史中的某个时刻，存在一个事件标志着精神分裂症的发病。研究对象选自由作者本人经手的病例。他们在青春期前和青春期持续且隐匿地出现精神分裂症症状，从幼儿期就表现出行为异常或类似神经症的体征。精神分裂症的诊断标准符合《精神疾病诊断与统计手册第三版》（DSM - III）以及德国的布鲁勒和施奈德理论。所有病例均已接受超过十年的治疗。由于诊断问题，排除了急性起病病例、智力发育迟缓病例（DSM - III.318）以及疑似器质性脑障碍病例。作者根据婴儿期的发育情况将这些研究对象分为三组。第一组是自闭症组，第二组是智力发育不全（DSM - III.317）或边缘组。这两组的精神问题在幼儿期就已明显。第三组在3至5岁前发育正常，之后出现伴有某种家庭内部问题的神经症症状。作者能够确认这三组在3至5岁时都表现出各种类似神经症的症状，主要是强迫症状。在这些病例中，被认为是儿童期精神病非爆发期的所谓潜伏期，可能对应于精神分裂症的前驱期。本研究基于对31名儿童的研究。作者对其中6名儿童进行了深入研究，上述三类中各选2名。在这些病例中未发现“转折”点。
