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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.

Minor physical abnormalities (MPA) are subtle dysmorphic features of bodily structures that have little or no impact on function. Most MPA develop during the first gestational trimester and are considered as important indicators of neuroectodermal deficiencies emerging during early brain development. A higher frequency of MPA was confirmed in schizophrenia patients and their relatives, when compared to controls. These findings are consistent with the neurodevelopmental model of schizophrenia. A neurodevelopmental component amongst other risk factors has also been recently proposed for anorexia nervosa (AN). The current study aimed to assess MPA frequency in adolescent inpatients with either schizophrenia spectrum disorders (SSD) or AN as compared to healthy controls (HC). The Waldrop Scale was used for assessing MPA. The mean MPA total score and mean head subscore was significantly higher in both test groups than in HC. There were no statistically significant differences between SSD and AN groups. The MPA profile (not frequency) was similar in all three groups. This finding is consistent both with widely acknowledged neurodevelopmental schizophrenia hypothesis as well as with more recent neurodevelopmental model of AN. Nevertheless, the findings should not be overgeneralized and further studies are warranted., (© 2021 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

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.

Background: Early-onset psychoses show substantial variability of diagnostic and functional outcome. Finding reliable prognostic factors may allow to allocate resources to those with the worst prognosis. The aim of the study was to gain new insights regarding the potential value of baseline negative and positive symptoms as predictors of outcome in psychoses of early onset., Method: Sixty-three patients with early-onset schizophrenia spectrum psychosis hospitalized in an adolescent psychiatry unit were assessed with the Positive and Negative Syndrome Scale during the index admission. Associations with diagnosis, illness course and functional outcome were analysed in mean 8 years of follow-up (range 3.4-13.5 years)., Results: The mean age at the index admission and the follow-up was 16.6 ± 1.2 and 24.5 ± 3.0 years, respectively. A significant majority of subjects continued psychiatric treatment (95%) and had been readmitted (71%). The mortality rate was 3% (suicide and accident). Negative symptoms were related to mental health service utilization during the follow-up. General severity of symptoms, specifically positive and cognitive factors were associated with the diagnosis of schizophrenia and inversely with diagnostic shift outside the schizophrenia spectrum at the catamnesis. Poor impulse control at baseline was associated with worse functional outcome. The drug-free subgroup with no occupational/educational activity compared with the drug-treated subjects showed lower levels of baseline negative symptomatology., Conclusion: The study findings suggest that in patients with early-onset psychosis negative and positive symptoms show a differential prognostic value. Pharmacotherapy may attenuate the effect of symptoms on functional outcome. These hypotheses need to be tested in future studies using confirmatory approaches., (© 2014 S. Karger AG, Basel.)

Objectives: Despite inclusion of adolescent insanity-a concept proposed by Thomas Clouston in late XIX century-into the broader nosological entity of dementia praecox, the uniqueness of early psychosis is still discussed. The aim of the current study is the assessment of course and outcome in the large sample of early-onset psychosis subjects., Method: Of 299 patients hospitalized in the period 1998-2008 in an adolescent psychiatry ward with schizophrenia spectrum diagnosis 158 completed a follow-up interview. Data concerning current diagnosis, further admissions, current treatment status and occupational and relationship outcome were analyzed after a mean of 8 years of follow-up., Results: Mean age at the index admission and the follow-up was 16.6 ± 1.2 and 24.5 ± 3.0 years respectively. After the subsequent discharge almost all subjects (97%) at least briefly continued psychiatric treatment and 75% of patients had been readmitted. Overall diagnostic stability was 42%. For schizophrenia spectrum disorders and schizophrenia diagnostic stability was 72% and 78%, respectively. At the follow-up assessment 119 (77.3%) of the traced subjects declared current psychiatric treatment and 110 (73.3%) were receiving pharmacotherapy. Almost half of the subjects (48%) were employed or studying and more than a third (35.8%) remained in a stable relationship. Different distributions of baseline diagnoses were observed in males and females, and the latter showed a better outcome., Conclusion: Early-onset psychoses were characterized by limited diagnostic stability, a necessity for further treatment and hospitalizations and significant percentage of unfavorable functional outcomes. Baseline diagnosis of acute and transient psychotic disorders and female gender were associated with an overall better outcome., (Copyright © 2014 Elsevier Inc. All rights reserved.)

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.

Background: Cognitive impairment and formal thought disorder, also referred to as communication disturbances, are considered the core symptoms of schizophrenia, strongly affecting social functioning and long-term outcome. Several studies in adult patients suggest improvement of both functions after the treatment with atypical antipsychotic drugs. Such medications are also used as first line treatment in early-onset schizophrenia, however their efficacy in cognitive and communication domains in this population have not been systematically assessed., Aim of the Study: Evaluation of risperidone efficacy at psychopathological symptoms, cognitive impairment and formal thought disorder in adolescents with schizophrenia spectrum diagnosis., Material and Method: Psychopathological symptoms, cognitive functioning and formal thought disorder were evaluated in 32 hospitalized adolescent patients with schizophrenia spectrum diagnosis at the beginning of risperidone treatment and after clinical improvement and compared to the results of matched healthy control group., Results: Risperidone treatment was associated with reduction of symptom severity and moderate improvement of formal thought disorder and some aspects of executive functions. Working memory and verbal fluency were not improved. There were few correlations between psychopathological symptoms and results of cognitive tests, mainly between negative symptoms and executive functions., Discussion: In early-onset schizophrenia spectrum disorders atypical antipsychotic treatment is associated with alleviation of symptoms and only selective and moderate cognitive and communication improvement., (Copyright © 2012 Elsevier Inc. All rights reserved.)

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.

Background: Both cognitive impairment and formal thought disorder (communication disturbances) found in patients with schizophrenia are also commonly observed in their relatives. Recently, the role of such deficits as putative endophenotypes of schizophrenia has been proposed. However, in a majority of studies, the families of adult patients were assessed whereas the relatives of early-onset psychotic subjects were rarely studied. The aim of our study was to evaluate the presence of cognitive impairment and formal thought disorders in parents of adolescents with a diagnosis of schizophrenia spectrum disorder (SSD) and in matched healthy controls., Method: Thirty-eight parents of 29 SSD adolescents and 38 healthy controls were assessed with a battery of neurocognitive tests and the Thought, Language and Communication Scale., Results: Parents of schizophrenia patients showed an increased tendency for perseverative thinking when compared to matched healthy controls. No statistically significant differences in cognitive functioning were observed between the groups., Conclusion: These results may suggest the need for further exploration of communication disturbances as a potential endophenotypic marker of early-onset schizophrenia., (Copyright © 2012 S. Karger AG, Basel.)

Aim: Analysis of a clinical presentation and course of psychotic episodes in adolescent inpatients., Method: A retrospective analysis of charts of all (n=104) inpatients diagnosed with one of the schizophrenia-spectrum disorders (schizophrenia, schizotypal disorder and acute and transient psychotic disorders: F20, F21 and F23 according to ICD-10) and assessed with the Positive and Negative Syndrome Scale (PANSS) over a 10-year period (1998-2008) in the Child and Adolescent Psychiatry Department. A psychopathological profile of different disorders and correlation between symptoms and demographic and clinical data were analysed., Results: Severity of symptoms correlated with length of hospitalisation. In schizophrenia higher PANSS total score and more severe some general symptoms then in schizotypal disorders were observed. Also in schizophrenia more negative symptoms then in acute and transient psychotic disorders were detected. In all three disorders, the psychopathological profile included negative symptoms., Conclusion: In schizophrenia psychopathological symptoms were more severe than in other disorders. Presence of negative symptoms may indicate that all schizophrenia spectrum disorders may have a neurodevelopmental component.

Objective: Although formal thought disorder and cognitive impairment are key features of schizophrenia, only a few studies evaluated both in adolescent population., Method: 32 inpatients with early-onset schizophrenia spectrum disorders (SSD) and 32 matched healthy controls were studied with Thought, Language and Communication Scale and battery of neurocognitive tests and SSD subjects were also assessed with Positive and Negative Syndrome Scale and Clinical Global Impression Scale., Results: Patients presented impairment in both cognitive functioning and formal thought processes. Communication disturbances correlated with executive and verbal fluency dysfunction., Conclusion: Communication disturbances in adolescent SSD patients may have both dysexecutive and dyssemantic origin.

Introduction: There is a relative dearth of studies assessing the course of early onset psychoses especially other than schizophrenia. Objectives: Follow-up assessment of level of functioning in early onset psychosis. Aims: Analysis of the course and outcome in early onset psychoses. Assessment of prognostic significance of psychopathological symptoms profile in the early course of illness. Methods: 144 patients with schizophrenia spectrum diagnosis (F20 - F29 according to International Classification of Diseases Tenth Revision ICD-10), hospitalized in the period June 1998 - June 2008 in Child and Adolescent Psychiatry Department was interviewed a mean 7.3 years after the index hospitalization. During interview data concerning course of illness after discharge and present level of functioning were obtained. For 50 of the patients with available results of baseline assessment with Positive and Negative Syndrome Scale these data were also analyzed. Results: Mean age at the index hospitalization was 16.9 years, mean age at the follow-up assessment 24,3 years. Psychotropic drugs were currently receiving 72% of patients. In some kind of educational or vocational activity were engaged 68% of patients. Mortality rate was 2%. Baseline diagnosis of schizophrenia was associated with higher number of hospitalizations, current pharmacotherapy and lower probability of being in romantic relationship. Negative symptoms present during index hospitalization were associated with more intensive further treatment, but not with the current level of functioning. Conclusions: Baseline diagnosis and baseline level of negative symptoms were associated with mental health services utilization but had little impact on functional outcome. [Copyright &y& Elsevier]