CHILDHOOD ONSET SCHIZOPHRENIA

儿童期发病的精神分裂症

• 批准号: 2578763
• 负责人: J L RAPOPORT
• 金额: --
• 依托单位: NATIONAL INSTITUTE OF MENTAL HEALTH
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/2578763
• 关键词: adolescence (12-20); child (0-11); chromosome deletion; chromosome translocation; clinical research; clozapine; developmental psychology; diagnosis quality /standard; family genetics; haloperidol; human subject; human therapy evaluation; interview; magnetic resonance imaging; mass screening; medical records; mental disorder chemotherapy; mental disorder diagnosis; neurobiology; psychopharmacology; visual tracking

Children and adolescents meeting DSM-III-R criteria for schizophrenia are being obtained through vigorous national recruiting. Thirty subjects have participated to date in this study of the phenomenology, neurobiology and pharmacologic response to childhood onset schizophrenia. Over 700 medical records have been reviewed from which 140 patients appearing to meet DSM-III-R criteria for schizophrenia with onset of psychosis prior to age 12, were screened in person. A total of 35 received the diagnosis of schizophrenia at screening. A large number of children are receiving the diagnosis of schizophrenia inappropriately resulting in inappropriate treatment, even at major academic centers. Our findings to date indicate continuity between childhood onset and later onset schizophrenia, with evidence that childhood onset schizophrenia may result from a more severe neurodevelopment lesion. Pilot family/genetic data indicate three cases (10%) are familial, not higher than seen with NIMH adult cases; a fourth subject had a 1:7 balance chromosomal translocation; a fifth subject had a microdeletion at 22q11. Three of 26 full siblings are mentally retarded. There is greater premorbid developmental delay particularly for language, than seen for the latter onset disorder. Autonomic and eye tracking measures parallel these of adult schizophrenia but may represent a more consistent and stronger pattern. MRI abnormalities resemble those results from adults, with a 9% smaller brain volume which is correlated with negative symptoms. A double-blind comparison of haloperidol and clozapine shows the superiority of clozapine for this very ill treatment refractory population. All subjects were pubertal by the time of admission, with no evidence of precocious puberty in any subject. Development of secondary sex characteristics was related to onset of psychosis in girls but not in boys. Cerebral glucose metabolism during performance of the auditory CPT in a subset of subjects age 12 or older indicated hypofrontalilty which was related to negative symptoms but which was not more severe that that seen in later onset schizophrenia. Childhood onset schizophrenics have a more significant general failure of brain development which may be of evidence of very early onset illness.

符合 DSM-III-R 精神分裂症标准的儿童和青少年是 是通过全国大力招募获得的。 三十个科目 迄今为止已经参与了这项现象学研究， 对儿童期发病的精神分裂症的神经生物学和药理学反应。 已审查了 700 多份医疗记录，其中 140 名患者 似乎符合 DSM-III-R 精神分裂症发病标准 12 岁之前的精神病患者均接受了亲自筛查。 共 35 个 在筛查时被诊断为精神分裂症。 大量 儿童不恰当地接受了精神分裂症的诊断 导致不适当的治疗，即使在主要学术中心也是如此。 迄今为止，我们的研究结果表明儿童期发病和 晚发性精神分裂症，有证据表明儿童期发病 精神分裂症可能是由更严重的神经发育损伤引起的。 飞行员家庭/遗传数据表明三例 (10%) 是家族性的，而不是 高于 NIMH 成人病例；第四个科目的成绩为 1:7 平衡染色体易位；第五名受试者有微缺失 2011 年 22 季度。 26 个兄弟姐妹中有 3 个患有智力障碍。 有 病前发育迟缓，尤其是语言发育迟缓，比 见于后者发病的障碍。 自主和眼动追踪措施 与成人精神分裂症相似，但可能代表更一致的情况 和更强的模式。 MRI 异常类似于以下结果 成年人的脑容量小 9%，这与负相关 症状。 氟哌啶醇和氯氮平的双盲比较显示 氯氮平对于这种病情严重、难治的患者的优越性 人口。 所有受试者在入院时均处于青春期， 没有任何受试者出现性早熟的证据。 发展 第二性征与女孩精神病的发生有关 但男孩则不然。 执行过程中的脑葡萄糖代谢 12 岁或以上受试者的听觉 CPT 表明 额功能减退，与阴性症状相关，但与阴性症状无关 比晚发型精神分裂症更严重。 儿童期发病 精神分裂症患者有更显着的一般性脑功能衰竭 发育，这可能是很早发病的疾病的证据。