Structural brain abnormalities in early onset first-episode psychosis.

BACKGROUND: Brain morphometry in children and adolescents with first-episode psychosis offer a unique opportunity for pathogenetic investigations. METHODS: We compared high-resolution 3D T1-weighted magnetic resonance images of the brain in 29 patients (schizophrenia, schizotypal disorder, delusional disorder or other non-organic psychosis), aged 10-18 to those of 29 matched controls, using optimized voxel-based morphometry. RESULTS: Psychotic patients had frontal white matter abnormalities, but expected (regional) gray matter reductions were not observed. Post hoc analyses revealed that schizophrenia patients (n = 15) had significantly larger lateral ventricles as compared to controls. Duration and dose of antipsychotics correlated negatively with global gray matter volume in minimally medicated patients (n = 18). CONCLUSION: Findings of white matter changes and enlarged lateral ventricles already at illness onset in young schizophrenia spectrum patients, suggests aberrant neurodevelopmental processes in the pathogenesis of these disorders. Gray matter volume changes, however, appear not to be a key feature in early onset first-episode psychosis.

A 20-year study of an adolescent psychiatric clientele, with special reference to the age of onset.

During a period of 20 years (1968-1988) all inpatients admitted for the first time to the adolescent psychiatric unit in Copenhagen (n = 841) were classified in accordance with social and psychiatric variables, to describe the clientele as a group and, furthermore, to investigate changes occurring during that period. The total clientele had a broad age range (12-21 years), with as many as 36% less than 15 years old. Eleven percent of the patients had attempted suicide before admission. Fifty-six percent of the total group were diagnosed as psychotic or as borderline cases. The patients came predominantly from lower social levels, and almost half the group had a child debut defined as symptoms that had resulted in referral for further investigation during childhood. Moreover, among the schizophrenic patients 35% had an early onset. The age of onset may have some clinical significance, as this item was related to several sociodemographic variables. Finally, an increase in the rate of psychoses and lower social class was recorded during the period.

A 10-year follow-up study of an adolescent psychiatric clientele and early predictors of readmission.

Over a period of 20 years (from 1968 to 1988) all inpatients (n = 839) who were admitted for the first time to the adolescent psychiatric unit in Copenhagen were registered, and 40 social and psychiatric variables were recorded, to investigate early predictors of later readmission. Overall, 44.8% of the patients were readmitted within a certain observation period (range, 1.5-21.5 years). Among a subsample of 488 patients (58%) who could be followed up for more than 10 years after their first admission 26% became heavy users of psychiatric services, defined as long-term inpatients or revolving-door patients. Severe early diagnoses (schizophrenia and affective psychoses) were strongly associated with rapid relapses and frequent readmissions. A statistical estimate of the risk of later heavy use based on 12 independent variables is presented.

[The adolescent psychiatric clientele in a district psychiatric center]. / Det ungdomspsykiatriske klientel i et distriktspsykiatrisk center.

This study is retrospective and based on the charts of 44 adolescents (age 17-22) admitted to a Danish community psychiatric centre during the first 32 months after the opening of the centre. The social status of the adolescents, reasons for admission, previous treatment and need for psychiatric treatment are presented. The adolescents were generally a little older than a typical adolescent psychiatric clientele, and comparatively many of them had rather mild psychiatric conditions. A characteristic feature of these patients was a certain instability in their contact to the centre. Although many of them had long-lasting basic disabilities (e.g. personality disorders), only a few of them achieved a stable treatment alliance with the ward. This indicates difficulties of integrating an adolescent clientele in a community psychiatric centre that primarily takes care of adult patients.

Schizophrenia in early adolescence. A study illustrated by long-term cases.

The purpose of this paper is to draw attention to schizophrenias starting in early adolescence, before age 15. Diagnosis may be difficult because such early manifestations may differ from the classical schizophrenias and from the traditional subgroups. The authors caution against a too liberal interpretation of normal problems in adolescence. In comment on the literature, particular weight is placed on descriptions of schizophrenias in adolescence. Some typical early manifestations of schizophrenia are described including, among other traits, depressive states and sociopathic behaviour. Key symptoms such as thought disturbances or flattening of affect may be lacking. Five long-term cases were chosen. None was classified in childhood as infantile borderline. A diagnosis of schizophrenia was made in adolescence. In the cases where Schneider's criteria are not fulfilled, other hard evidence of schizophrenia is given. Emphasis is placed on the importance of early diagnosis.

Borderline and psychotic adolescents' relationship to their parents: a therapeutic point of view.

This study investigated the parents of 100 psychotic and borderline adolescents, and their relationships with their adolescent children. The incidence of psychiatric disorders among the parents, and the incidence of one-parent homes, as well as the divorce rate of biological parents, are given. A direct assessment of the number of pathological relationships between adolescents and parents, defined from a therapeutic point of view, was also made. Examples are given of parental pathology or marital discord concealed in the adolescents' pathology, or in the parent-adolescent relationship. It was concluded that the assessment of parents and their relationships with the adolescents is important for the treatment of the adolescent.

Borderline and psychotic adolescents: Borderline symptomatology from childhood - Actual therapeutic approach.

Of 100 borderline and psychotic adolescents, 21 had suffered from borderline psychoses in childhood. This study investigated the symptoms of these adolescents and therapeutic possibilities from a developmental point of view. It concluded that therapeutic possibilities exist. Some childhood symptoms can be used directly in treating adolescents. Other symptoms disappear with general improvement. The therapeutic possibilities are not dependent upon the age of the symptom. Psychopharmacological treatment does not preclude psychodynamically oriented therapy.

Psychotic and borderline psychotic adolescents: frequency of psychiatric illness and treatment in childhood in 100 consecutive cases.

The first results covering the assessment period phase of a systematic study of 50 borderline psychotic and 50 psychotic adolescents are described. These 100 adolescents comprised one-third of the total number of admissions to an adolescent department during the years from 1968 to 1975. There were 58 boys and 42 girls; 53 of the 100 cases had been psychiatrically ill in childhood with evident symptoms. In 22 cases, there was positive information supporting the fact that the patients had been healthy in childhood. The rest (25 cases) were classified under "unclarified picture", showing non specific symptoms. It is concluded that in this material more than half of the adolescents had shown some instability before puberty. The illnesses described in childhood are categorised as infantile borderline psychosis, borderline psychosis probable, and other psychiatric illnesses. A shift in diagnosis is often seen in the individual case, but the symptoms in childhood and in adolescence have many similarities. The necessary treatment in childhood has not been given in one-third of the cases. The possible reasons for this are discussed. In spite of much effort in some cases and because of resistance to therapy or the proposal of inadequate therapy in others, the therapeutic possibilities in childhood have not been fully realised. It is recommended that more emphasis be placed on the emotional development in the evaluation of the children. In the treatment, development of interpersonal relationships through individual, family and/or milieu therapy should be stressed. A follow-up of children with symptoms in childhood left untreated and a teamwork between child psychiatrist and adult psychiatrist with longitudinal studies is suggested.