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Schizophrenia Bulletin Advance Access originally published online on February 16, 2005
Schizophrenia Bulletin 2005 31(3):769-780; doi:10.1093/schbul/sbi014
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© The Author 2005. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oupjournals.org.

Long-Term Course of Adolescent Schizophrenia

Christian Fleischhaker, M.D.
Consultant, Department of Child and Adolescent Psychiatry, Albert Ludwigs University, Freiburg, Germany

Eberhard Schulz, M.D.
Professor of Child and Adolescent Psychiatry and Head, Department of Child and Adolescent Psychiatry, Albert Ludwigs University

Kathrin Tepper, M.D.
Physician, Department of Child and Adolescent Psychiatry, Philipps University, Marburg, Germany

Matthias Martin, M.D.
Professor of Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Philipps University

Klaus Hennighausen, M.D.
Consultant, Department of Child and Adolescent Psychiatry, Albert Ludwigs University

Helmut Remschmidt, M.D., Ph.D.
Professor of Child and Adolescent Psychiatry and Head, Department of Child and Adolescent Psychiatry, Philipps University

Send reprint requests to Dr. Christian Fleischhaker, Department of Child and Adolescent Psychiatry, Albert Ludwigs University Freiburg, Hauptstr. 8, D–79104 Freiburg, Germany; e-mail: fleischhaker{at}psyallg.ukl.uni-freiburg.de.

Our study investigated premorbid functioning, course, and outcome in early-onset schizophrenia. All inpatients with DSM–III–R diagnoses of schizophrenia (n = 101) consecutively admitted between 1983 and 1988 to the Department of Child and Adolescent Psychiatry at the University of Marburg in Germany were included. To assess premorbid adaptation and precursor symptoms, we administered the Instrument for the Retrospective Assessment of the Onset of Schizophrenia, which we modified to assess children and adolescents. Symptomatology was measured by the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms, and the Brief Psychiatric Rating Scale. In addition, the Global Assessment of Functioning was applied. Followup data for 81 patients (80.2%) were available. The mean duration of schizophrenia at followup was 9.5 ± 2.2 years. Assessment of the highest level of adaptive functioning revealed very good or good outcome in 19.8 percent of the patients, fair or poor outcome in 38.2 percent, and very poor outcome and gross impairment in 42.0 percent. Premorbid adjustment was the best predictor of outcome in our schizophrenia sample. A poor prognosis was found in patients with premorbid developmental delays and those who were introverted and withdrawn before their psychotic state.

Keywords: Early-onset schizophrenia / course / outcome / premorbid development


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