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Schizophrenia Bulletin 1994 20(4):697-712; doi:10.1093/schbul/20.4.697
© 1994 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
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© Oxford University Press

This article appears in the following Schizophrenia Bulletin issue: Featured Topic: Childhood-Onset Schizophrenia [View the issue table of contents]

Childhood-Onset Schizophrenia: An NIMH Study in Progress

Charles T. Gordon, M.D., Senior Staff Fellow, Jean A. Frazier, M.D., Senior Staff Fellow, Kathleen McKenna, M.D., Senior Staff Fellow, Jay Giedd, M.D., Senior Staff Fellow, Alan Zametkin, M.D., Senior Staff Psychiatrist, Debra Kaysen, B.A., Research Assistant, Kathleen E. Albus, B.A., Research Assistant, Judith L. Rapoport, M.D., Branch Chief, Theodore Zahn, Ph.D., Senior Staff Research Psychologist, Walter Hong, M.D., Senior Staff Fellow and Dan Hommer, M.D., Section Chief
Child Psychiatry Branch, National Institute of Mental Health (NIMH) Bethesda, MD
Laboratory of Psychology and Psychopathology, NIMH Bethesda, MD
Laboratory of Neurosciences, National Institute on Aging Bethesda, MD
Laboratory of Clinical Studies, National Institute on Alcohol Abuse and Alcoholism Bethesda, MD

Reprint requests should be sent to Dr. J.A. Frazier, Child Psychiatry Branch, National Institute of Mental Health, Bldg. 10, Rm. 6N240, 9000 Rockville Pike, Bethesda, MD 20892

An ongoing study of the phenomenology, genetics, neuropsychology, physiology (eye tracking, autonomic responsivity), neuroimaging, biochemistry, and pharmacology of childhood-onset schizophrenia is described, and pilot data are presented for the first 22 subjects. Differentiation from autism "spectrum" disorders and other poorly defined, severe neurodevelopmental disorders is needed. Eye tracking and autonomic results are similar to patterns seen in later-onset schizophrenia and possibly more striking. Magnetic resonance imaging showed larger left frontal ventricular horn area for the schizophrenia subjects, larger left caudate, and lack of normal caudate asymmetry. Fluoro-deoxyglucose positron emission tomography during an auditory continuous performance task revealed decreased right parietal/occipital glucose metabolic rate in the schizophrenia subjects, which may be secondary to poor attentional performance, and increased glucose metabolic rate in three left frontal regions, a left parietal region, and the right putamen. Clozapine has been effective and well tolerated in an open trial with 12 adolescents who responded poorly to typical neuroleptics; 16 subjects have been enrolled in a double-blind comparison of haloperidol and clozapine. Longitudinal study of this narrowly defined and possibly more homogeneous group of very early-onset schizophrenia subjects will be relevant to current neurodevelopmental theories addressing the role of puberty, progression of pathology, and continuity or discontinuity with later-onset schizophrenia.


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