Russell A T
Dept. of Psychiatry and Biobehavioral Sciences, UCLA Neuropsychiatric Institute 90024.
Schizophr Bull. 1994;20(4):631-46. doi: 10.1093/schbul/20.4.631.
This review describes the symptomatic presentation of schizophrenia with onset in childhood. Phenomenologic data from an original sample of 35 children with onset before the age of 12, from the University of California, Los Angeles (UCLA) Childhood-Onset Schizophrenia Research Program, are presented and compared with similar data from two other major studies. Similarities and differences between childhood-onset and adult-onset forms of the disorder are discussed, with special emphasis on gender ratio and mode of onset. Among the 35 children in the UCLA study, 80 percent presented with auditory hallucinations, 74 percent with flat or inappropriate affect, 63 percent with delusions, 40 percent with formal thought disorder, and 37 percent with visual hallucinations. In the vast majority of cases onset was insidious. The mean age at onset of general psychiatric symptoms was estimated to be 4.6 years, the mean age at onset of psychotic symptoms was 6.9 years, and the mean age at diagnosis was 9.5 years. The phenomenology of the UCLA sample is compared with two other major studies of childhood-onset schizophrenia. The relative frequency of core symptoms, with the exception of thought disorder, was strikingly similar across the three studies, as was the mode of onset. The groups were also similar in age at diagnosis, gender ratio, and IQ. Limited comparisons with studies of first-onset schizophrenia in adults suggest basic similarities between schizophrenia with onset in childhood and adulthood. The qualitative nature of the symptoms reported is similar to that seen in adult cases with the expected developmental variations, for example, delusions are less complex in children and reflect childhood themes. Limited data from a cross-sectional assessment using DSM-III criteria indicate that the relative frequency of core symptoms may also be similar to that seen in adult cases. In contrast to previous reports, this review suggests that the high male to female ratio seen in childhood-onset cases represents a continuum with young adult cases, and gender ratio does not truly distinguish childhood-onset from (young) adult-onset forms of the disorder. Schizophrenia with onset before adolescence does seem to differ from later-onset cases in the very high rates of insidious as opposed to acute onset. The insidious onset may also help explain the clinical observation that in some children psychotic symptoms, particularly those of long duration, can be relatively ego-syntonic.
本综述描述了儿童期起病的精神分裂症的症状表现。来自加利福尼亚大学洛杉矶分校（UCLA）儿童期起病精神分裂症研究项目的35名12岁前起病儿童的原始样本的现象学数据被呈现出来，并与其他两项主要研究的类似数据进行比较。讨论了该疾病儿童期起病和成年期起病形式之间的异同，特别强调了性别比例和起病方式。在UCLA研究的35名儿童中，80%出现幻听，74%情感平淡或不恰当，63%出现妄想，40%出现形式思维障碍，37%出现幻视。在绝大多数病例中，起病隐匿。一般精神症状的平均起病年龄估计为4.6岁，精神病性症状的平均起病年龄为6.9岁，诊断的平均年龄为9.5岁。将UCLA样本的现象学与其他两项儿童期起病精神分裂症的主要研究进行比较。除思维障碍外，三项研究中核心症状的相对频率以及起病方式都极为相似。这些组在诊断年龄、性别比例和智商方面也相似。与成年期首次起病精神分裂症研究的有限比较表明，儿童期起病和成年期起病的精神分裂症之间存在基本相似之处。所报告症状的质性本质与成年病例中所见相似，但有预期的发育差异，例如，儿童的妄想不太复杂，且反映儿童主题。使用《精神疾病诊断与统计手册》第三版（DSM - III）标准进行的横断面评估的有限数据表明，核心症状的相对频率可能也与成年病例中所见相似。与先前报告不同的是，本综述表明，儿童期起病病例中高男性与女性比例与青年成人病例构成一个连续体，性别比例并不能真正区分该疾病的儿童期起病和（青年）成年期起病形式。青春期前起病的精神分裂症似乎与晚发病例不同，隐匿起病的比例非常高，而非急性起病。隐匿起病也可能有助于解释临床观察结果，即在一些儿童中，精神病性症状，尤其是持续时间长的症状，可能相对与自我和谐。
