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Çocuk ve Ergenlerde Şizofreninin Klinik Profili: Tanı, Belirtiler ve Prognoz

Year 2025, Volume: 51 Issue: 1, 67 - 73, 27.05.2025

Hurşit Ferahkaya , Ayşegül Tuğba Hıra Selen

https://doi.org/10.32708/uutfd.1633893

Abstract

Şizofreni geniş bir klinik yelpazesi olan bireyin işlevselliğini belirgin olarak bozan psikiyatrik bir bozukluktur. 18 yaşın altında daha nadir görülmekte ve klinik belirtiler, tanı, tedavi ve takip süreçleri erişkin dönem şizofrenisinden bazı yönleri ile ayrılmaktadır. Bu çalışma, erken başlangıçlı şizofreni (EOS) ve çocukluk başlangıçlı şizofreni (COS) tanısı almış hastaların sosyodemografik ve klinik özelliklerini değerlendirmeyi amaçlamaktadır. Retrospektif olarak tasarlanan bu çalışmada DSM-5 kriterlerine göre şizofreni tanısı almış 83 çocuk ve ergen hasta incelenmiştir. Hastaların sosyodemografik özellikleri, ilk semptom yaşı, tanı alma süresi, komorbiditeleri ve tedavi süreçleri analiz edilmiştir. Hastaların ortalama şizofreni tanısı alma yaşı 14,42 ± 2,46 yıl olarak belirlenmiştir. İlk psikiyatrik semptomun ortaya çıkışı ile şizofreni tanısı alma arasında geçen süre ortalama 11,1 ± 1,56 ay olarak saptanmıştır. İlk psikiyatrik tedaviye başlama yaşı ortalama 13,26 ± 3,10 yıl ve en sık kullanılan ilaç grubu olan antipsikotik ilaçlara başlama yaşı ortalama 13,93 ± 2,82 yıl olarak saptanmıştır. Komorbid psikiyatrik bozukluklar yaygındı ve en sık DEHB ve entelektüel yetiyitimi gözlendi. Ayrıca, hastaların %19’unun annesinde ve %20’sinin babasında psikiyatrik bozukluk öyküsü saptanmıştır. Çalışmamız, EOS ve COS tanısı alan hastaların sosyodemografik ve klinik özelliklerini belirleyerek, tanı sürecinde yaşanan gecikmelere ve komorbid bozuklukların yaygınlığına dikkat çekmektedir. Erken tanı ve müdahale süreçlerinin güçlendirilmesi, bireyselleştirilmiş tedavi yaklaşımlarının benimsenmesi ve multidisipliner yaklaşımlar ile hastaların uzun vadeli işlevselliğinin artırılması gerektiği vurgulanmaktadır.

Keywords

çocukluk çağı başlangıçlı şizofreni erken başlangıçlı şizofreni sosyodemografik özellikler komorbid psikiyatrik bozukluklar

References

  • 1. Alkelai A, Greenbaum L, Shohat S, Povysil G, Malakar A, Ren Z, et al. Genetic insights into childhood-onset schizophrenia: The yield of clinical exome sequencing. Schizophr Res 2023;252:138–45. https://doi.org/10.1016/j.schres.2022.12.033.
  • 2. Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry 2022;27:281–95. https://doi.org/10.1038/s41380-021-01161-7.
  • 3. Lieberman JA, Perkins D, Belger A, Chakos M, Jarskog F, Boteva K, et al. The early stages of schizophrenia: speculations on pathogenesis, pathophysiology, and therapeutic approaches. Biol Psychiatry 2001;50:884–97. https://doi.org/10.1016/S0006-3223(01)01303-8.
  • 4. McClellan J, Stock S. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Schizophrenia. J Am Acad Child Adolesc Psychiatry 2013;52:976–90. https://doi.org/10.1016/j.jaac.2013.02.008.
  • 5. Liu Y, Guo W, Zhang Y, Lv L, Hu F, Wu R, et al. Decreased Resting-State Interhemispheric Functional Connectivity Correlated with Neurocognitive Deficits in Drug-Naive First-Episode Adolescent-Onset Schizophrenia. Int J Neuropsychopharmacol 2018;21:33–41. https://doi.org/10.1093/ijnp/pyx095.
  • 6. Tor J, Dolz M, Sintes A, Muñoz D, Pardo M, de la Serna E, et al. Clinical high risk for psychosis in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2018;27:683–700. https://doi.org/10.1007/s00787-017-1046-3.
  • 7. Taylor JH, Huque ZM. Commentary: Schizophrenia prevention and prodromal psychosis in children and adolescents. J Child Psychol Psychiatry 2021;62:674–6. https://doi.org/10.1111/jcpp.13408.
  • 8. Baykal S, Bozkurt A, Çobanoğlu Osmanlı C, Önal BS, Şahin B, Karadoğan ZN, et al. A comparison of clinical characteristics and course predictors in early‐ and childhood‐onset schizophrenia. Early Interv Psychiatry 2025;19. https://doi.org/10.1111/eip.13594.
  • 9. Stentebjerg-Olesen M, Pagsberg AK, Fink-Jensen A, Correll CU, Jeppesen P. Clinical Characteristics and Predictors of Outcome of Schizophrenia-Spectrum Psychosis in Children and Adolescents: A Systematic Review. J Child Adolesc Psychopharmacol 2016;26:410–27. https://doi.org/10.1089/cap.2015.0097.
  • 10. Coulon N, Godin O, Bulzacka E, Dubertret C, Mallet J, Fond G, et al. Early and very early‐onset schizophrenia compared with adult‐onset schizophrenia: French FACE‐SZ database. Brain Behav 2020;10. https://doi.org/10.1002/brb3.1495.
  • 11. Howes OD, McCutcheon R, Agid O, de Bartolomeis A, van Beveren NJM, Birnbaum ML, et al. Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology. Am J Psychiatry 2017;174:216–29. https://doi.org/10.1176/appi.ajp.2016.16050503.
  • 12. Hashimoto K. Recent Advances in the Early Intervention in Schizophrenia: Future Direction from Preclinical Findings. Curr Psychiatry Rep 2019;21:75. https://doi.org/10.1007/s11920-019-1063-7.
  • 13. Morgan C, Fearon P, Lappin J, Heslin M, Donoghue K, Lomas B, et al. Ethnicity and long-term course and outcome of psychotic disorders in a UK sample: The ÆSOP-10 study. Br J Psychiatry 2017;211:88–94. https://doi.org/10.1192/bjp.bp.116.193342.
  • 14. Uher R, Zwicker A. Etiology in psychiatry: embracing the reality of poly‐gene‐environmental causation of mental illness. World Psychiatry 2017;16:121–9. https://doi.org/10.1002/wps.20436.
  • 15. Rutter M. Annual Research Review: Resilience – clinical implications. J Child Psychol Psychiatry 2013;54:474–87. https://doi.org/10.1111/j.1469-7610.2012.02615.x.
  • 16. Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R. Prior Juvenile Diagnoses in Adults With Mental Disorder. Arch Gen Psychiatry 2003;60:709. https://doi.org/10.1001/archpsyc.60.7.709.
  • 17. Solmi M, Seitidis G, Mavridis D, Correll CU, Dragioti E, Guimond S, et al. Incidence, prevalence, and global burden of schizophrenia - data, with critical appraisal, from the Global Burden of Disease (GBD) 2019. Mol Psychiatry 2023;28:5319–27. https://doi.org/10.1038/s41380-023-02138-4.
  • 18. Driver DI, Thomas S, Gogtay N, Rapoport JL. Childhood-Onset Schizophrenia and Early-onset Schizophrenia Spectrum Disorders. Child Adolesc Psychiatr Clin N Am 2020;29:71–90. https://doi.org/10.1016/j.chc.2019.08.017.
  • 19. Remschmidt H, Theisen F. Early-onset schizophrenia. Neuropsychobiology 2012;66:63–9. https://doi.org/10.1159/000338548.
  • 20. Hollis C. Developmental precursors of child- and adolescent-onset schizophrenia and affective psychoses: diagnostic specificity and continuity with symptom dimensions. Br J Psychiatry 2003;182:37–44. https://doi.org/10.1192/bjp.182.1.37.
  • 21. Williams JA, Burgess S, Suckling J, Lalousis PA, Batool F, Griffiths SL, et al. Inflammation and Brain Structure in Schizophrenia and Other Neuropsychiatric Disorders. JAMA Psychiatry 2022;79:498. https://doi.org/10.1001/jamapsychiatry.2022.0407.
  • 22.Remschmidt H, Theisen FM. Schizophrenia and related disorders in children and adolescents. Neurodev. Disord., Vienna: Springer-Verlag; n.d., p. 121–41. https://doi.org/10.1007/3-211-31222-6_7.
  • 23.Correll C, Arango C, Fagiolini A, Giordano G, Leucht S, Salazar de Pablo G. Finding the Right Setting for the Right Treatment During the Acute Treatment of Individuals with Schizophrenia: A Narrative Review and Clinical Practice Guideline. Neuropsychiatr Dis Treat 2024;Volume 20:1293–307. https://doi.org/10.2147/NDT.S459450.
  • 24.Cheng X, Zhang H, Zhang J, Xu P, Jin P, Fang H, et al.Comparison of clinical characteristics and treatment efficacy in childhood-onset schizophrenia and adolescent-onset schizophrenia in mainland China: A retrospective study. EarlyInterv Psychiatry 2021;15:1721–9. https://doi.org/10.1111/eip.13121.

Clinical Profile of Schizophrenia in Children and Adolescents: Diagnosis, Symptoms and Prognosis

Year 2025, Volume: 51 Issue: 1, 67 - 73, 27.05.2025

Hurşit Ferahkaya , Ayşegül Tuğba Hıra Selen

https://doi.org/10.32708/uutfd.1633893

Abstract

Schizophrenia is a psychiatric disorder with a wide clinical spectrum that significantly impairs the functionality of the individual. It is less common under 18 years of age and clinical symptoms, diagnosis, treatment and follow-up processes differ from adult schizophrenia in certain aspects. This study aims to evaluate the sociodemographic and clinical characteristics of patients diagnosed with early-onset schizophrenia (EOS) and childhood-onset schizophrenia (COS). In this retrospective study, 83 children and adolescents diagnosed with schizophrenia according to DSM-5 criteria were analyzed. Sociodemographic characteristics, age at first symptom, duration of diagnosis, comorbidities and treatment processes of the patients were analyzed. The mean age at diagnosis of schizophrenia was 14.42 ± 2.46 years. The mean time between the first psychiatric symptom and the diagnosis of schizophrenia was 11.1 ± 1.56 months. The mean age of starting the first psychiatric treatment was 13.26 ± 3.10 years and the mean age of starting the most commonly used drug group, antipsychotic drugs, was 13.93 ± 2.82 years. Comorbid psychiatric disorders were common, with ADHD and intellectual disability being the most frequently observed. In addition, 19% of the patients had a history of psychiatric disorders in their mothers and 20% in their fathers. Our study highlights the delays in the diagnostic process and the prevalence of comorbid disorders by determining the sociodemographic and clinical characteristics of patients diagnosed with EOS and COS. It is emphasized that early diagnosis and intervention processes should be strengthened, individualized treatment approaches should be adopted, and long-term functionality of patients should be increased with multidisciplinary approaches.

Keywords

childhood-onset schizophrenia early-onset schizophrenia sociodemographic characteristics comorbid psychiatric disorders

Ethical Statement

Approved by Necmetin Erbakan University Pharmaceutical and Non-Medical Device Research Ethics Committee (Approval Date: 06.09.2024, Decision No: 2024/5165)

Supporting Institution

This research has not received any financial support from funding organisations in the public, commercial or non-profit sectors.

References

  • 1. Alkelai A, Greenbaum L, Shohat S, Povysil G, Malakar A, Ren Z, et al. Genetic insights into childhood-onset schizophrenia: The yield of clinical exome sequencing. Schizophr Res 2023;252:138–45. https://doi.org/10.1016/j.schres.2022.12.033.
  • 2. Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry 2022;27:281–95. https://doi.org/10.1038/s41380-021-01161-7.
  • 3. Lieberman JA, Perkins D, Belger A, Chakos M, Jarskog F, Boteva K, et al. The early stages of schizophrenia: speculations on pathogenesis, pathophysiology, and therapeutic approaches. Biol Psychiatry 2001;50:884–97. https://doi.org/10.1016/S0006-3223(01)01303-8.
  • 4. McClellan J, Stock S. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Schizophrenia. J Am Acad Child Adolesc Psychiatry 2013;52:976–90. https://doi.org/10.1016/j.jaac.2013.02.008.
  • 5. Liu Y, Guo W, Zhang Y, Lv L, Hu F, Wu R, et al. Decreased Resting-State Interhemispheric Functional Connectivity Correlated with Neurocognitive Deficits in Drug-Naive First-Episode Adolescent-Onset Schizophrenia. Int J Neuropsychopharmacol 2018;21:33–41. https://doi.org/10.1093/ijnp/pyx095.
  • 6. Tor J, Dolz M, Sintes A, Muñoz D, Pardo M, de la Serna E, et al. Clinical high risk for psychosis in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2018;27:683–700. https://doi.org/10.1007/s00787-017-1046-3.
  • 7. Taylor JH, Huque ZM. Commentary: Schizophrenia prevention and prodromal psychosis in children and adolescents. J Child Psychol Psychiatry 2021;62:674–6. https://doi.org/10.1111/jcpp.13408.
  • 8. Baykal S, Bozkurt A, Çobanoğlu Osmanlı C, Önal BS, Şahin B, Karadoğan ZN, et al. A comparison of clinical characteristics and course predictors in early‐ and childhood‐onset schizophrenia. Early Interv Psychiatry 2025;19. https://doi.org/10.1111/eip.13594.
  • 9. Stentebjerg-Olesen M, Pagsberg AK, Fink-Jensen A, Correll CU, Jeppesen P. Clinical Characteristics and Predictors of Outcome of Schizophrenia-Spectrum Psychosis in Children and Adolescents: A Systematic Review. J Child Adolesc Psychopharmacol 2016;26:410–27. https://doi.org/10.1089/cap.2015.0097.
  • 10. Coulon N, Godin O, Bulzacka E, Dubertret C, Mallet J, Fond G, et al. Early and very early‐onset schizophrenia compared with adult‐onset schizophrenia: French FACE‐SZ database. Brain Behav 2020;10. https://doi.org/10.1002/brb3.1495.
  • 11. Howes OD, McCutcheon R, Agid O, de Bartolomeis A, van Beveren NJM, Birnbaum ML, et al. Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology. Am J Psychiatry 2017;174:216–29. https://doi.org/10.1176/appi.ajp.2016.16050503.
  • 12. Hashimoto K. Recent Advances in the Early Intervention in Schizophrenia: Future Direction from Preclinical Findings. Curr Psychiatry Rep 2019;21:75. https://doi.org/10.1007/s11920-019-1063-7.
  • 13. Morgan C, Fearon P, Lappin J, Heslin M, Donoghue K, Lomas B, et al. Ethnicity and long-term course and outcome of psychotic disorders in a UK sample: The ÆSOP-10 study. Br J Psychiatry 2017;211:88–94. https://doi.org/10.1192/bjp.bp.116.193342.
  • 14. Uher R, Zwicker A. Etiology in psychiatry: embracing the reality of poly‐gene‐environmental causation of mental illness. World Psychiatry 2017;16:121–9. https://doi.org/10.1002/wps.20436.
  • 15. Rutter M. Annual Research Review: Resilience – clinical implications. J Child Psychol Psychiatry 2013;54:474–87. https://doi.org/10.1111/j.1469-7610.2012.02615.x.
  • 16. Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R. Prior Juvenile Diagnoses in Adults With Mental Disorder. Arch Gen Psychiatry 2003;60:709. https://doi.org/10.1001/archpsyc.60.7.709.
  • 17. Solmi M, Seitidis G, Mavridis D, Correll CU, Dragioti E, Guimond S, et al. Incidence, prevalence, and global burden of schizophrenia - data, with critical appraisal, from the Global Burden of Disease (GBD) 2019. Mol Psychiatry 2023;28:5319–27. https://doi.org/10.1038/s41380-023-02138-4.
  • 18. Driver DI, Thomas S, Gogtay N, Rapoport JL. Childhood-Onset Schizophrenia and Early-onset Schizophrenia Spectrum Disorders. Child Adolesc Psychiatr Clin N Am 2020;29:71–90. https://doi.org/10.1016/j.chc.2019.08.017.
  • 19. Remschmidt H, Theisen F. Early-onset schizophrenia. Neuropsychobiology 2012;66:63–9. https://doi.org/10.1159/000338548.
  • 20. Hollis C. Developmental precursors of child- and adolescent-onset schizophrenia and affective psychoses: diagnostic specificity and continuity with symptom dimensions. Br J Psychiatry 2003;182:37–44. https://doi.org/10.1192/bjp.182.1.37.
  • 21. Williams JA, Burgess S, Suckling J, Lalousis PA, Batool F, Griffiths SL, et al. Inflammation and Brain Structure in Schizophrenia and Other Neuropsychiatric Disorders. JAMA Psychiatry 2022;79:498. https://doi.org/10.1001/jamapsychiatry.2022.0407.
  • 22.Remschmidt H, Theisen FM. Schizophrenia and related disorders in children and adolescents. Neurodev. Disord., Vienna: Springer-Verlag; n.d., p. 121–41. https://doi.org/10.1007/3-211-31222-6_7.
  • 23.Correll C, Arango C, Fagiolini A, Giordano G, Leucht S, Salazar de Pablo G. Finding the Right Setting for the Right Treatment During the Acute Treatment of Individuals with Schizophrenia: A Narrative Review and Clinical Practice Guideline. Neuropsychiatr Dis Treat 2024;Volume 20:1293–307. https://doi.org/10.2147/NDT.S459450.
  • 24.Cheng X, Zhang H, Zhang J, Xu P, Jin P, Fang H, et al.Comparison of clinical characteristics and treatment efficacy in childhood-onset schizophrenia and adolescent-onset schizophrenia in mainland China: A retrospective study. EarlyInterv Psychiatry 2021;15:1721–9. https://doi.org/10.1111/eip.13121.
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Details

Primary Language English
Subjects Psychiatry
Journal Section Research Article
Authors

Hurşit Ferahkaya 0000-0001-8611-0435

Ayşegül Tuğba Hıra Selen 0000-0003-1065-5548

Publication Date May 27, 2025
Submission Date February 5, 2025
Acceptance Date March 24, 2025
Published in Issue Year 2025 Volume: 51 Issue: 1

Cite

AMA Ferahkaya H, Hıra Selen AT. Clinical Profile of Schizophrenia in Children and Adolescents: Diagnosis, Symptoms and Prognosis. Uludağ Tıp Derg. May 2025;51(1):67-73. doi:10.32708/uutfd.1633893
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ISSN: 1300-414X, e-ISSN: 2645-9027

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