[Anti-NMDA-receptor encephalitis: a new axis-III disorder in the differential diagnosis of childhood disintegrative disorder, early onset schizophrenia and late onset autism]. / Anti-NMDA-receptorencefalitis: een nieuwe as III-stoornis in de differentiaaldiagnose van desintegratiestoornis van de kinderleeftijd, vroeg optredende schizofrenie en laat optredend autisme.

Childhood disintegrative disorder (CDD), early onset schizophrenia (EOS), and late onset autism (LOA) often follow a similar course: initially, development is normal, then there is a sudden neuropsychiatric deterioration of social interaction and communication skills, which is combined with a decline in intelligence and reduction in daily activities. A 9-year-old boy was admitted to the paediatric ward with acute onset of secondary epileptic seizures. It was not long until the boy's symptoms resembled that of patients with cdd, eos and loa. Intensive tests led to the diagnosis of anti-NMDA-receptor encephalitis. Anti-NMDA-receptor encephalitis should be regarded as a possible organic cause underlying the syndromal presentation of CDD, EOS and LOA.

DSM-III and DSM-III-R diagnoses of autism.

The authors examined the reliability, sensitivity, and specificity of DSM-III and DSM-III-R criteria for autism in relation to each other and to clinical diagnoses in 114 children and adults (52 diagnosed by clinicians' best judgment as autistic and 62 as nonautistic but developmentally disordered). They used a standard, structured coding scheme to evaluate each patient. The reliability of specific criteria was generally high. Although DSM-III criteria were highly specific, they were less sensitive; the reverse was true for DSM-III-R. The authors conclude that the diagnostic concept of autism in DSM-III-R appears to have been substantially broadened.

DSM-III in the clinical practice of child psychiatry.

The clinical usefulness of DSM-III was assessed by examining its inclusiveness, its correspondence to DSM-II, and difficulties encountered in its use in evaluations of 108 children. DSM-III covered adequately a wide range of diagnostic entities, showed relatively good correspondence to DSM-II with some exceptions, and presented relatively few major difficulties in a child psychiatry clinic setting. DSM-III seems likely to be accepted and used by a majority of practicing child psychiatrists.

Conceptualizing "borderline syndrome of childhood" and "childhood schizophrenia" as a developmental disorder.

OBJECTIVE: This is the first attempt to define and validate criteria for an early onset, chronic syndrome of disturbances in affect modulation, social relatedness, and thinking. This study formulates and tests five hypotheses that follow from conceptualizing this syndrome as a developmental disorder. The advantages of viewing this syndrome as a developmental disorder are discussed and compared with alternative formulations such as childhood schizophrenia or borderline syndrome of childhood. METHOD: An inpatient cohort (26 boys, 4 girls) was ascertained using specific, defined criteria. Using standardized measures on retrospective chart reviews, these subjects were compared with two different inpatient samples: one diagnosed with dysthymic disorder, the other with conduct disorder. RESULTS: The criteria readily distinguished between developmentally disordered children and comparison groups. Findings also supported the hypotheses in the predicted directions; index subjects had earlier onset of symptoms, poorer social and overall adjustment, longer hospitalizations, and poorer outcomes. CONCLUSIONS: Findings support the validity of this developmental concept for a multiple complex developmental disorder and give preliminary, "first-cut" validity to these specified criteria.

"Multidimensionally impaired disorder": is it a variant of very early-onset schizophrenia?

OBJECTIVE: To examine the validity of diagnostic criteria for a subgroup of children with atypical psychosis (n = 19), designated here as "multidimensionally impaired." These children are characterized by poor attention and impulse control, psychotic symptoms, and poor affective control. METHOD: Children and adolescents (n = 19) meeting our criteria for multidimensionally impaired syndrome with onset of psychotic symptoms at or before age 12 years were identified from a total of 150 in-person screenings for very early-onset schizophrenia between 1990 and 1996. We compared the premorbid adjustment, family history, follow-up status, and laboratory measures for a subgroup of these children with those of (1) a rigorously defined group of 29 children with DSM-III-R schizophrenia and (2) 19 children with attention-deficit hyperactivity disorder. RESULTS: Patients with multidimensionally impaired syndrome and patients with very early-onset schizophrenia shared a similar pattern of early transient autistic features, postpsychotic cognitive decline, and an elevated risk of schizophrenic-spectrum disorders among their first-degree relatives. This pattern was not seen in the attention-deficit hyperactivity disorder group. In contrast to very early-onset schizophrenia, the multidimensionally impaired group had significantly poorer scores on the Freedom From Distractibility factor on the WISC-R, a less deviant pattern of autonomic reactivity, and no progression to schizophrenia. CONCLUSIONS: The findings support the distinction of the multidimensionally impaired cases as separate from those with other psychiatric disorders, and there is somewhat greater evidence to suggest that this disorder belongs in the schizophrenia spectrum.

Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data.

OBJECTIVE: To describe the psychometric properties of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) interview, which surveys additional disorders not assessed in prior K-SADS, contains improved probes and anchor points, includes diagnosis-specific impairment ratings, generates DSM-III-R and DSM-IV diagnoses, and divides symptoms surveyed into a screening interview and five diagnostic supplements. METHOD: Subjects were 55 psychiatric outpatients and 11 normal controls (aged 7 through 17 years). Both parents and children were used as informants. Concurrent validity of the screen criteria and the K-SADS-PL diagnoses was assessed against standard self-report scales. Interrater (n = 15) and test-retest (n = 20) reliability data were also collected (mean retest interval: 18 days; range: 2 to 36 days). RESULTS: Rating scale data support the concurrent validity of screens and K-SADS-PL diagnoses. Interrater agreement in scoring screens and diagnoses was high (range: 93% to 100%). Test-retest reliability kappa coefficients were in the excellent range for present and/or lifetime diagnoses of major depression, any bipolar, generalized anxiety, conduct, and oppositional defiant disorder (.77 to 1.00) and in the good range for present diagnoses of posttraumatic stress disorder and attention-deficit hyperactivity disorder (.63 to .67). CONCLUSION: Results suggest the K-SADS-PL generates reliable and valid child psychiatric diagnoses.

Childhood and adolescent psychosis: a review of the past 10 years.

OBJECTIVE: Developmental aspects of psychosis are reviewed and related to the more frequent psychotic conditions in children and adolescents. METHOD: The review of the recent literature focuses on developmental aspects of psychotic phenomena, i.e., hallucinations, delusions, and thought disorder. RESULTS: While the applicability of much early work on this topic is limited, more recent work suggests that psychotic conditions are observed in childhood and increase in frequency during adolescence. CONCLUSIONS: Developmental factors in the expression of psychosis are relevant to the diagnosis and treatment of such conditions.

Childhood-onset schizophrenia: editors' introduction.

Descriptions of various psychotic symptoms in children began to appear in the psychiatric literature at about the same time as descriptions of psychotic symptoms in adults. For example, Kraepelin estimated that at least 3.5 percent of his cases of dementia praecox had onsets before age 10. The construct of "childhood schizophrenia" initially emerged from attempts to classify a broad range of psychotic children. By the late 1940s and 1950s, the diagnosis of "childhood schizophrenia" was given to many disturbed children who today would be considered to have infantile autism and other developmental disabilities. In the early 1970s infantile autism and its variants was differentiated from schizophrenia of childhood onset. These changes were incorporated in DSM-III, which returned to the practice before 1930 of diagnosing schizophrenia in children using the same criteria as for adults, with minor allowances for differences in the manifestations of these symptoms during childhood. The studies presented in this issue of Schizophrenia Bulletin use DSM-III, DSM-III-R, or ICD-9 criteria for schizophrenia.

Information-processing deficits across childhood- and adult-onset schizophrenia.

Event-related potentials were recorded for childhood- and adult-onset schizophrenia subjects performing the span of apprehension (Span) task, which is sensitive to vulnerability factors in schizophrenia. Subjects responded to the onset of the Span arrays in a reaction time condition and then responded differentially to the presence of one of two target letters in the Span condition. While neither the childhood- nor the adult-onset group exhibited abnormalities in preparatory contingent negative variation activity, both groups produced significantly less endogenous negative activity between 100 and 300 ms after Span stimulus onset than age-matched normals. This endogenous negative activity reflects attentional effort associated with serial search and stimulus identification. These results support the position that schizophrenia subjects are impaired in their ability to allocate adequate attentional resources for processing Span stimuli. Moreover, the similarity of this information-processing deficit in the two groups suggests that childhood- and adult-onset schizophrenia lie on a continuum in this regard.

The clinical presentation of childhood-onset schizophrenia.

This review describes the symptomatic presentation of schizophrenia with onset in childhood. Phenomenologic data from an original sample of 35 children with onset before the age of 12, from the University of California, Los Angeles (UCLA) Childhood-Onset Schizophrenia Research Program, are presented and compared with similar data from two other major studies. Similarities and differences between childhood-onset and adult-onset forms of the disorder are discussed, with special emphasis on gender ratio and mode of onset. Among the 35 children in the UCLA study, 80 percent presented with auditory hallucinations, 74 percent with flat or inappropriate affect, 63 percent with delusions, 40 percent with formal thought disorder, and 37 percent with visual hallucinations. In the vast majority of cases onset was insidious. The mean age at onset of general psychiatric symptoms was estimated to be 4.6 years, the mean age at onset of psychotic symptoms was 6.9 years, and the mean age at diagnosis was 9.5 years. The phenomenology of the UCLA sample is compared with two other major studies of childhood-onset schizophrenia. The relative frequency of core symptoms, with the exception of thought disorder, was strikingly similar across the three studies, as was the mode of onset. The groups were also similar in age at diagnosis, gender ratio, and IQ. Limited comparisons with studies of first-onset schizophrenia in adults suggest basic similarities between schizophrenia with onset in childhood and adulthood. The qualitative nature of the symptoms reported is similar to that seen in adult cases with the expected developmental variations, for example, delusions are less complex in children and reflect childhood themes. Limited data from a cross-sectional assessment using DSM-III criteria indicate that the relative frequency of core symptoms may also be similar to that seen in adult cases. In contrast to previous reports, this review suggests that the high male to female ratio seen in childhood-onset cases represents a continuum with young adult cases, and gender ratio does not truly distinguish childhood-onset from (young) adult-onset forms of the disorder. Schizophrenia with onset before adolescence does seem to differ from later-onset cases in the very high rates of insidious as opposed to acute onset. The insidious onset may also help explain the clinical observation that in some children psychotic symptoms, particularly those of long duration, can be relatively ego-syntonic.

Communication deficits in childhood schizophrenia spectrum disorders.

This article examines the effects of age, cognition, and discourse skills on the clinical manifestations of formal thought disorder in 31 children with schizophrenia, 14 with schizotypal personality disorder (SPD), and 70 who were normal. The communication deficits of the 31 children with schizophrenia have three characteristics: illogical thinking, loose associations, and impaired discourse skills. Loose associations and illogical thinking reflect different aspects of impaired attention/information processing in children with schizophrenia. Only certain aspects of the discourse deficits of the children with schizophrenia are associated with the cognitive measures used in this study. The children with SPD have similar illogical thinking and loose associations scores but a narrower range of discourse deficits than the children with schizophrenia. Implications of the interaction between the clinical, cognitive, and discourse manifestations of the communication deficits of children with schizophrenia are discussed. The possible relationship between these manifestations and positive and negative symptoms of schizophrenia are also reviewed.

Attention deficits in childhood-onset schizophrenia: reaction time studies.

The hypothesis of continuity between childhood-onset and adult schizophrenia was tested by comparing the performance of 15 patients with childhood-onset schizophrenia and 52 age-matched controls on 2 reaction time paradigms that have been used to study adult schizophrenia. On simple reaction time to tones with regular and irregular preparatory intervals of 2, 4, and 8 s, patients showed greater effects of the length of the preparatory interval in the regular condition and greater effects of the preparatory interval (girls only) and the preceding preparatory interval in the irregular series. On simple reaction time to random lights and tones, patients were faster on ipsimodal sequences than cross-modal sequences compared with controls. Overall, patients were much slower than controls in both paradigms. The results suggest similar attention dysfunction as is found in adult schizophrenia and thus are consistent with the continuity hypothesis.

Child and adolescent (early onset) schizophrenia: a review in light of DSM-III-R.

Early onset schizophrenia (EOS) is defined as that beginning in childhood or adolescence (under 16 or 17). Studies of EOS are infrequent, and comparative adult figures not always available, but tentative conclusions may be drawn. EOS is more common in males; symptomatology is often undifferentiated; frequencies of homotypic family disorder, premorbid schizotypal personality, and neurodevelopmental abnormalities high; outcome poor but only slightly worse than in adults; response to psychotropic drug treatment probably similar though not properly tested; and confusion with psychotic bipolar disorder particularly common. Onset before language is developed presents special diagnostic difficulties. There are a few reports of autistic children developing schizophrenia but this requires replication. Differences from adult schizophrenia are more marked when onset is in childhood than in adolescence but all are quantitative rather than qualitative suggesting that the disorders are the same and that there should be no separate category for children or adolescents.

Child and adolescent psychopathology research: problems and prospects for the 1990s.

In November 1990 the National Institute of Mental Health (NIMH) convened a special conference of over 100 scientists and leaders to outline specific strategies and research initiatives that should be developed to implement the recently released National Plan for Research on Child and Adolescent Mental Disorders. Participants included journal editors, educators from psychology and psychiatry, representatives from private foundations, and leaders of research program areas in public funding agencies. Critical knowledge gaps were identified in five areas of child and adolescent psychopathology, including depression, attention deficit hyperactivity disorder, conduct disorder, the anxiety disorders, and the developmental disorders. For each of these areas, special emphasis was placed on developing new ideas and obtaining critical input from other areas of investigation. This report summarizes the identified research gaps and recommends research initiatives to implement the National Plan, as outlined by the conference participants.

[Characteristics of the development of juvenile schizophrenia in view of the late catamnesis]. / Nekotorye osobennosti razvitiia iunosheskoi shizofrenii v svete otdalennogo katamneza.

By means of a clinico-follow-up method the author studied 751 schizophrenic patients with the onset of the disease in adolescence and a catamnesis more than 10 years. It was established that in 96.5% of the cases the diagnostic evaluation made in inpatient conditions was correct. A comparison of the assessment of forms in the development of schizophrenia during the first examination and during follow-up study demonstrated that in most of the cases the first determination of the form of the development on the initial stages of the disease in adolescence was justified, but the frequency of correct initial assessment of the forms of development was different in various clinical states. Despite the formed opinion concerning the prevalent unfavourable outcome of schizophrenia with the onset in adolescence, on the remote stages there was a high percentage of patients under outpatient observation (80.7%), and those working at an ordinary production (40%). In many cases (49.6%) there was a frequent alleviation of the process activity on remote stages and formation of remission.

[Genetic classification of clinical forms of childhood schizophrenia]. / Geneticheskaia sistematika klinicheskikh form detskoi shizofrenii.

In an analysis of 225 families of probands with different forms of the course of children's schizophrenia, a hypothesis on the degree of their genetical similarity (or dissimilarity) was tested. Malignant and slow progredient form of children schizophrenia showed major genetical similarity (correlation coefficient 1.0) with the recurrent schizophrenia occupying a separate position having no common genetical predisposition factors with nuclear forms of schizophrenia. Paroxysmal progredient schizophrenia displayed a distinct genetical relation to any other form (genetical correlation coefficient ranging in 0.5-0.7).

[Classification of the course of childhood schizophrenia in the light of long-term follow-up]. / Sistematika form techenia detskoi shizofrenii v svete otdalennogo katamneza.

The work deals with the catamnestic substantiation of the systematics of schizophrenia in children. A group of 328 patients was selected in 1982-1987 from a cohort of schizophrenic patients studied in 1962-1972 in which the onset of the disease fell on their first 5 years. The stability of the course patterns was evidenced in the early childhood schizophrenia. A set of subspecies of disorders similar to schizoactive psychoses and peculiar affective schizoid states was differentiated out of the general pool of slow progredient and attack-like schizophrenia. This allowed to prove the notion of the whole continuum of endogenous psychoses in not only adults but also in children.

[Epistemologic perspectives for a nosography in child psychiatry]. / Perspectives épistémologiques d'une nosographie en psychiatrie de l'enfant.

The author tries to question psychiatric nosography based on references. To do so, after defining nosography as well as psychiatric and medical nosography, he studies two ideas of thought. The first is a causal medical way dealing with child schizophrenia as developed in Eastern European psychiatry, whereas the second deals with the structural psychopathological way which describes the concept of child psychosis, the dominant way of dealing with child psychiatry in France.

[On schizophrenic cases which present neurosis-like symptoms from early childhood--in relation to the prodromal signs and childhood schizophrenia].

The concept of "childhood schizophrenia" is ambiguous because of problems on the diagnostic level, especially in regard to symptomatology and prognosis. After studies which produced the description of "early infantile autism", childhood schizophrenia studies were even more confused. One reason for this was that there were not sufficient follow-up studies about the schizophrenia-like psychoses during occurring childhood, on the one hand, and the retrospective-anamnestic research was limited in the field of adult psychiatry, on the other hand. The author has focused on two points of view in order to discuss the problem of childhood schizophrenia. One is the non outbreak of childhood psychoses in children from 6 to 8 years old which was demonstrated by a couple of epidemiological research studies. The other is the concept of "Knick" (in Germany) which usually accompanies classical German theories of schizophrenia. "Knick" means that, at some point in the patient's history, there is an incident that is the indication of the onset of schizophrenia. The subjects were selected from the author's own cases. They continuously and insidiously developed schizophrenic symptoms during pre-puberty and puberty, presenting behavioral abnormalities or neurosis-like signs from early childhood. The diagnostic criteria for schizophrenia corresponds to DSM-III and with the German theory of Bleuler and Schneider. All cases have been treated for more than ten years. The acute onset cases, the mentally retarded cases (DSM-III .318) and the cases with suspected organic brain disorders were excluded because of the diagnostic problems. The author could differentiate these subjects into three groups based on the development in the infantile stage. The first was autistic group and the second mentally subnormal (DSM-III .317) or borderline group. Psychiatric problems of these two groups were already obvious in early childhood. The third group developed normally until they were 3-5 years old. After that they presented neurotic symptoms having some kind of intra-familiar problems. The author could confirm that these three groups manifested various kinds of neurosis-like symptoms, mainly obsessive-compulsive ones, from 3-5 years old. The so-called latent time, which is thought to be a non-outbreak time of childhood psychoses, may correspond to the prodromal stage of schizophrenia in these cases. This research is based on study of 31 children. An in-depth study has been done by the author of 6 of these children, 2 in each of the 3 categories described above. The "Knick"-points were not identifiable in these cases.(ABSTRACT TRUNCATED AT 400 WORDS)