Woodberry Kristen A, Serur Rachael A, Hallinan Sean B, Mesholam-Gately Raquelle I, Giuliano Anthony J, Wojcik Joanne D, Keshavan Matcheri S, Frazier Jean A, Goldstein Jill M, Shenton Martha E, McCarley Robert W, Seidman Larry J
Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States.
Schizophr Res. 2014 Sep;158(1-3):45-51. doi: 10.1016/j.schres.2014.05.017. Epub 2014 Jun 10.
Psychosis prevention and early intervention efforts in schizophrenia have focused increasingly on sub-threshold psychotic symptoms in adolescents and young adults. Although many youth report symptom onset prior to adolescence, the childhood incidence of prodromal-level symptoms in those with schizophrenia or related psychoses is largely unknown.
This study reports on the retrospective recall of prodromal-level symptoms from 40 participants in a first-episode of schizophrenia (FES) and 40 participants at "clinical high risk" (CHR) for psychosis. Onset of positive and non-specific symptoms was captured using the Structured Interview for Prodromal Syndromes. Frequencies are reported according to onset during childhood (prior to age 13), adolescence (13-17), or adulthood (18+).
Childhood-onset of attenuated psychotic symptoms was not rare. At least 11% of FES and 23% of CHR reported specific recall of childhood-onset of unusual or delusional ideas, suspiciousness, or perceptual abnormalities. Most recalled experiencing non-specific symptoms prior to positive symptoms. CHR and FES did not differ significantly in the timing of positive and non-specific symptom onset. Other than being younger at assessment, those with childhood onset did not differ demographically from those with later onset.
Childhood-onset of initial psychotic-like symptoms may be more common than previous research has suggested. Improved characterization of these symptoms and a focus on their predictive value for subsequent schizophrenia and other major psychoses are needed to facilitate screening of children presenting with attenuated psychotic symptoms. Accurate detection of prodromal symptoms in children might facilitate even earlier intervention and the potential to alter pre-illness trajectories.
精神分裂症的精神病预防和早期干预工作越来越关注青少年和青年中的亚阈值精神病症状。尽管许多年轻人报告症状在青春期之前就已出现，但精神分裂症或相关精神病患者前驱期症状的儿童发病率在很大程度上尚不清楚。
本研究报告了40名首次发作精神分裂症（FES）参与者和40名精神病“临床高危”（CHR）参与者对前驱期症状的回顾性回忆。使用前驱综合征结构化访谈来记录阳性症状和非特异性症状的发作情况。根据儿童期（13岁之前）、青春期（13 - 17岁）或成年期（18岁及以上）的发作情况报告频率。
儿童期出现的减弱的精神病症状并不罕见。至少11%的FES参与者和23%的CHR参与者报告明确回忆起在儿童期出现异常或妄想观念、猜疑或感知异常。大多数人回忆在出现阳性症状之前经历过非特异性症状。CHR和FES在阳性症状和非特异性症状发作时间上没有显著差异。除了评估时年龄较小外，儿童期起病者在人口统计学特征上与较晚起病者没有差异。
最初类似精神病症状的儿童期起病可能比先前研究所表明的更为常见。需要更好地描述这些症状，并关注它们对后续精神分裂症和其他主要精神病的预测价值，以促进对出现减弱的精神病症状儿童的筛查。准确检测儿童的前驱症状可能有助于更早进行干预，并有可能改变疾病前的轨迹。
