Jacobsen L K, Rapoport J L
Child Psychiatry Branch, NIMH, Bethesda, Maryland, MD 20892, USA.
J Child Psychol Psychiatry. 1998 Jan;39(1):101-13.
Childhood-onset schizophrenia is a rare, clinically severe form of schizophrenia, which is associated with disrupted cognitive, linguistic, and social development well before the appearance of frank psychotic symptoms. This disruption of multiple developmental domains signals the important opportunity these patients present for examining neurodevelopmental and other etiologic hypotheses of schizophrenia. The present research update reviews studies of the phenomenology and neurobiology of childhood-onset schizophrenia conducted since 1994. Findings from these studies indicate that children can be diagnosed with schizophrenia using unmodified DSM-III, -IIIR, and -IV criteria, and that the atypical neuroleptic clozapine is an effective medication for this treatment refractory group. Neuropsychologic and neurobiologic studies generally support continuity with adult-onset schizophrenia, with evidence of more severe premorbid impairment. Longitudinal studies show preliminary evidence of progressive ventricular enlargement and more prolonged deterioration in intellectual function than is seen in the adult-onset disorder. If replicated, these observations, together with the insidious onset of this disorder, would suggest that the pathologic underpinning of childhood-onset schizophrenia is not a single static lesion or event but may be a continuous or multi-event process.
儿童期起病的精神分裂症是一种罕见的、临床症状严重的精神分裂症形式，在明显的精神病性症状出现之前，就与认知、语言和社交发展的紊乱有关。多个发育领域的这种紊乱表明，这些患者为检验精神分裂症的神经发育及其他病因假说提供了重要契机。本研究进展综述了自1994年以来开展的关于儿童期起病精神分裂症的现象学和神经生物学研究。这些研究的结果表明，使用未经修改的《精神疾病诊断与统计手册》第三版、第三版修订本和第四版标准能够诊断儿童精神分裂症，并且非典型抗精神病药物氯氮平对这一难治性群体是一种有效的药物。神经心理学和神经生物学研究总体上支持与成人期起病精神分裂症的连续性，有证据表明病前损害更严重。纵向研究显示出初步证据，表明与成人期起病的疾病相比，儿童期起病精神分裂症存在进行性脑室扩大以及智力功能衰退持续时间更长的情况。如果这些观察结果得到重复验证，那么连同该疾病的隐匿起病情况一起，将表明儿童期起病精神分裂症的病理基础不是单一的静态损害或事件，而可能是一个连续的或多事件的过程。
