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The British Journal of Psychiatry (2003) 182: 37-44
© 2003 The Royal College of Psychiatrists

Developmental precursors of child- and adolescent-onset schizophrenia and affective psychoses: diagnostic specificity and continuity with symptom dimensions

CHRIS HOLLIS, MRCPsych

Section of Developmental Psychiatry, Division of Psychiatry, University of Nottingham, E Floor, South Block, Queen's Medical Centre, Nottingham NG7 2UH, UK.

Correspondence: Tel/fax: 0115 970 9946; e-mail: Chris.hollis{at}nottingham.ac.uk

Declaration of interest C.H. was funded by the Medical Research Council.

Background An increased rate of premorbid impairment has been reported in both child- and adolescent-onset schizophrenic and affective psychoses.

Aims To examine the evidence for a specific association between premorbid impairment and child- and adolescent-onset schizophrenia, and whether specific continuities exist between premorbid impairments and psychotic symptom dimensions.

Method Retrospective case note study of 110 first-episode child- and adolescent-onset psychoses (age 10-17 years). DSM—III—R diagnoses derived from the OPCRIT algorithm showed 61 with schizophrenia (mean age 14.1 years) and 49 with other non-schizophrenic psychoses (mean age 14.7 years).

Results Premorbid social impairment was more common in early-onset schizophrenia than in other early-onset psychoses (OR 1.9, P=0.03). Overall, impaired premorbid development, enuresis and incontinence during psychosis were specifically associated with the negative psychotic symptom dimension.

Conclusions Premorbid social impairments are more marked in child-and adolescent-onset schizophrenia than in other psychoses. There appears to be developmental continuity from premorbid impairment to negative symptoms.


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