Developmental insanity or dementia praecox: was the wrong concept adopted?

Over a century ago, the Scottish psychiatrist Thomas Clouston proposed the idea of a developmental or adolescent insanity. He characterised the condition as having a male predominance and a poor outcome, and noted the frequency of a family history and of minor anomalies of the palate; he considered it a disorder of cortical development and the onset of psychotic symptoms due to maturation during adolescence "of certain parts of the brain which had lain dormant before". Clouston's idea was subsequently eclipsed by the broader dementia-praecox espoused by Kraepelin and Bleuler, but recent epidemiological, neuroimaging, and neuropathological research supports the existence, within the schizophrenia syndrome of a group of patients with a severe, early onset, developmental psychosis. This disorder, re-christened as neurodevelopmental schizophrenia, is associated with childhood language and speech difficulties which render subjects more likely to later misinterpret their own inner speech as external voices; like all developmental disorders of language, it is commoner in males. Predisposing factors include the inheritance of abnormal cerebral asymmetry, and early environmental hazards of brain development such as prenatal exposure to maternal viral infection and perinatal complications.