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Early onset of schizophrenia (before the age of 18 years) is associated with a higher risk of delayed or missed diagnosis, more severe course of the disease, and an increased susceptibility to adverse reactions to antipsychotic drugs. The objective of this paper is to present the recommendations for the diagnostic and therapeutic management of patients with early-onset schizophrenia, developed on the basis of a literature review and a consensus of a group of experts working with schizophrenia therapy. The formal criteria that must be met to diagnose schizophrenia are the same for children and adults. Early-onset schizophrenia must be thoroughly differentiated from uni - or bipolar affective disorder, autism-spectrum disorders (ASDs) and anxiety disorder. Diagnostic assessment for psychotic disorders is also necessary in the case of abnormal, destructive or aggressive behaviour, or self-harm. The mainstay of schizophrenia treatment is pharmacological therapy, which is used in the treatment of acute episodes and in maintenance treatment - prevention of relapses. However, the use of pharmacological interventions in children and adolescents only to reduce the risk of psychosis development is not justified. Antipsychotic agents significantly differ by their tolerance profile and clinical efficacy. Second-generation antipsychotic agents approved for the treatment of early-onset schizophrenia - aripiprazole, lurasidone and paliperidone - enable its effective and safe treatment. The necessary complement to pharmacological therapy is non-pharmacological interventions that should be adapted to the patient's age, cognitive abilities, disease stage and the needs of the whole family.

Psychotic-like experiences (PLEs) are subtle, subclinical hallucinations and delusions which are quite common in general population. In children and youth prevalence rate is probably age-dependent with higher rate in younger population. PLEs are suggested to be a form of extended psychosis phenotype. Similar demographic, genetic and environmental risk factors observed for PLEs and schizophrenia support this hypothesis. Other mental health problems associated with PLEs include depression, suicidality, low functioning and psychiatric comorbidity. PLEs may be a risk factor for psychosis, but probably only for a minor subgroup of population. It is possible however, that PLEs are a risk factor for different psychiatric disorders. In the majority of children and adolescents PLEs disappear over time. PLEs are supposed to be a heterogenic phenomenon with different subtypes: associated with psychosis risk, associated with other psychiatric disorders and being within the normal range of experiences. Due to lack of widely acknowledged PLEs definition and because of substantial diversity of research methodology interpretation of the previous research should be made with caution.

Objective: Cognitive functions are important determinants of outcome in schizophrenia. Psychiatric hospitalization and intensive treatment in the early-onset psychosis may reduce the severity of psychotic symptoms and improve cognitive functions. It is not clear if after discharge improvement or further deterioration of cognition is observed. The aim of the current study is the evaluation of executive functioning in early onset schizophrenia (EOS) across stages of illness., Methods: Two groups of EOS patients: hospitalized subjects with first episode (FES, n=16) at the introduction of pharmacotherapy (T1) and after mean 7 weeks (T2) and stable outpatients group (SO, n=24) were assessed with the Wisconsin Card Sorting Test (WCST) the Positive and Negative Syndrome Scale. Matched healthy (n=32) controls were assessed with WCST., Results: All patients performed significantly worse in WCST than healthy controls. Subjects in acute psychotic episode (FES T1) presented more pronounced executive impairment and psychopathological symptoms than after the resolution of psychotic symptoms (FES T2). No differences in executive function between FES T2 and SO group were observed. In all assessments perseverative errors correlated with negative symptoms., Conclusion: Cognitive impairment is present at the onset of EOS and persists in attenuated but stable form after the resolution of psychotic symptoms.

Objectives: Early-onset psychoses (EOP) vary considerably with regard to diagnostic stability and functional outcome. The aim of this study was the assessment of executive dysfunction as a predictor of outcome in EOP., Method: This was a retrospective cohort study. Twenty-five hospitalized patients with non-affective EOP were assessed with the Wisconsin Card Sorting Test (WCST) during the index admission. Associations with current diagnosis, further admissions, current treatment status and occupational and relationship outcome were analyzed in 6 years of follow-up., Results: The mean age at the index admission and the follow-up was 16.1 ± 1.35 and 22.0 ± 2.1 years, respectively. After discharge, almost all subjects (96%) at least briefly continued psychiatric treatment, and the majority of them (76%) were readmitted. Worse baseline WCST results were associated with a follow-up schizophrenia diagnosis, being a psychiatric in- or outpatient at the moment of follow-up assessment and receiving psychotropic medication. A low number of completed categories correlated with receiving a disability pension at the follow-up., Conclusion: In patients with EOP, baseline executive function impairment was associated with schizophrenia diagnosis and psychiatric treatment at the follow-up. The association between baseline results and psychiatric treatment may explain the limited effect of baseline impairment on follow-up occupational and relationship status.

Aim: Analysis of clinical presentations and course of psychotic episodes in adolescent inpatients., Method: A retrospective analysis of charts of all (n = 300) hospitalised patients diagnosed with of one of the schizophrenia-spectrum disorders (F20-F29) over a 10-year span period (1998-2008) was conducted at the Child and Adolescent Department of Institute of Psychiatry and Neurology. The distribution of diagnoses was compared with a sample of 200 adult hospitalisations. Also, the demographic and clinical data, percentage of rehospitalisations and stability of the diagnosis was analysed., Results: The distribution of diagnoses in the schizophrenia spectrum of psychotic episodes was found to be different in adolescent patients than in adults. In further analysis of schizophrenia (F20), schizotypal disorder (F21), acute and transient psychotic disorder (F23) and schizoaffective disorder (F25) significant differences in the length of hospitalisation, gender distribution, frequency of rehospitalisation and stability of the diagnosis were observed. Stability of the diagnosis in the whole group was 52%. Schizophrenia was the most stable diagnosis., Conclusion: Distribution of schizophrenia spectrum diagnoses is different in adolescent and adult inpatients. In adolescents psychotic episodes other then schizophrenia are frequent. Diagnostic difficulties seemed to be confirmed by not very high diagnostic stability. However for F20, F21, F23 and F25 diagnoses different clinical and demographic profiles were observed, what may confirm that these disorders are separate nosological entities.