Schizophrenia - Children

The concept of the schizophrenia prodrome has generated considerable interest during the last few years because it suggests that it may be possible to alter the natural course of schizophrenia by intervening early in the disease process to reduce the progression to psychosis, relapse rate, or symptom severity (Kane, 2003). Several studies of prodromal schizophrenia, using a variety of rating scales to assess early signs of psychosis, have demonstrated that approximately 30% to 50% of patients with prodromal symptoms progress to schizophrenia within the first few years after presentation (Correll, 2004). One long-term, prospective study examined the transition to schizophrenia among 160 patients who were seeking help for psychiatric symptoms, but who did not meet diagnostic criteria for schizophrenia or other delusional or psychotic disorders at baseline (Klosterkotter, 2001). The relationship between prodromal symptoms, in this case so-called "basic symptoms" (ie, alterations in thinking and perceptions of self and the environment), at the time of first examination and the long-term transition to schizophrenia is shown in Table 1 (Klosterkotter, 2001). During a mean follow-up period of nearly 10 years, 77 of 110 patients (70%) with prodromal symptoms at first examination transitioned to schizophrenia, whereas only 2 of 50 patients (4%) without prodromal symptoms had transitioned to schizophrenia (correct prediction in 78%). Table 1. Number of Patients With and Without Prodromal Symptoms at First Examination With Regard to the Subsequent Development of Schizophrenia Prodromal Symptoms Present At First Examination	Transited to Psychosis in Follow-Up Period Yes	No	Σ Yes	77	33	110 No	2	48	50 Σ	79	81	160

Correct predictions occurred 78.1% of the time (χ21 = 59.9, P < .0001). From Klosterkotter, Arch Gen Psychiatry., 2001.

Patients may evolve through several specific phases of the schizophrenia prodrome (Correll, 2004; Cornblatt, 2003). The early prodromal period is characterized primarily by subtle, self-experienced deficits (eg, self-perception, stress tolerance, thought organization, and social and nonverbal interactions), as well as attenuated negative symptoms of schizophrenia (eg, social isolation, decreased expression of emotion, rigid or simplistic thinking, odd behavior or appearance, and impairments of personal hygiene). The later prodromal period is characterized to a greater extent by attenuated positive symptoms of schizophrenia (eg, unusual thought content, suspiciousness, grandiosity, perceptual abnormalities, and cognitive disorganization). The early, attenuated negative symptoms may also persist during this period. These symptom clusters are summarized in Table 2 (Correll, 2004). Table 2. Possible Prodromal Symptoms of Schizophrenia and Other Psychiatric Disorders Basic (self-experienced) symptoms	Attenuated negative symptoms	Attenuated positive symptoms Thought disturbance	Social isolation or withdrawal	Unusual thought content Thought interference, thought pressure, thought blocking, compulsive-like thought perseverance	Awkward or anxious, socially disinterested or reluctant, few friends outside of family, loner	Mind tricks, unanticipated beliefs, "magical" thinking, overvalued ideas Disturbance of sense of reality	Avolition	Suspiciousness Decreased ability to discriminate between ideas and perception, fantasy and true memories, derealization	Less/waning interest in pleasurable activities, diminished productivity, avoidance or abandonment of goal-directed activities	Wariness, hypervigilance, distrust, overvalued ideas of danger Disturbance of self-perception	Decreased expression of emotion	Grandiosity Unstable ideas of reference (subject-centrism)	Blunted affect, speech lacking in character, unengaging, aspontaneous, constricted or flat affect	Private thoughts of superiority, preoccupation with overvalued ideas Disturbance of receptive language	Decreased ideational richness	Perceptual abnormalities Disturbed read or heard language	Rigidity, simplicity or concrete thinking, repetitiveness, restriction to yes/no answers	Change in perceptual sensitivity, distortions, illusions, brief/vague hallucinations Visual perceptual disturbances	Deterioration in role functioning	Conceptual disorganization Blurred vision, transitory blindness, partial seeing, hypersensitivity to light, etc.	More effort needed to maintain achievement, difficulties, drop in performance, failing requirements	Vague, confused, inconsistent thoughts, circumstantial, paralogical thoughts, tangentiality Acoustic perceptual disturbances	Odd behavior or appearance Hypersensitivity to sounds or noise, acouasms, etc.	Eccentric, odd, awkward, unconventional, strange or bizarre hobbies, appearance, or behavior Impairment in personal hygiene and social attentiveness Less attentive or indifferent to, or neglectful of, social norms or hygiene

From Correll, Adv Schizophr Clin Psychiatry., 2004.