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Open Access Highly Accessed Research article

A systematic review of the long-term outcome of early onset schizophrenia

Lars Clemmensen1, Ditte Lammers Vernal2 and Hans-Christoph Steinhausen234*

  • * Corresponding author: Hans-Christoph Steinhausen hces@rn.dk

  • † Equal contributors

Author Affiliations

1 Research Unit at Glostrup Center of Child and Adolescent Psychiatry, Ndr. Ringvej 69, 2600, Glostrup, Denmark

2 Present address: Research Unit for Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aarhus University Hospital, Moelleparkvej 10, Aalborg, DK, 9000, Denmark

3 Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Missionsstrasse 60/62, Basel, CH, 4055, Switzerland

4 Department of Child and Adolescent Psychiatry, University of Zurich, Neptunstrasse 60, Zürich, H-8032, Switzerland

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BMC Psychiatry 2012, 12:150  doi:10.1186/1471-244X-12-150

Published: 19 September 2012

Abstract

Background

The current review analyzes the long-term outcome and prognosis of early onset schizophrenia based on previously published studies in 1980.

Methods

A systematic search of articles published in the English-language literature after 1980 identified a total of 21 studies, which included 716 patients who were either suffering from early onset schizophrenia (EOS) or both EOS and other psychotic disorders (MIX). The authors of the current review scored the outcome as either “good,” “moderate,” or “poor.” The mean age of onset in these studies was <18 years.

Results

In general, the outcome in studies with EOS is worse than the outcome in MIX studies. Only 15.4% of the patients in EOS studies versus 19.6% of the patients in MIX studies experienced a “good” outcome. In contrast, 24.5% of the patients in EOS studies versus 33.6% in MIX studies experienced a “moderate” outcome, and 60.1% in EOS studies versus 46.8% in MIX studies experienced a “poor” outcome. The authors identified various significant effects on outcome. In EOS, the findings were significantly affected by sample attrition, indicating that in studies with a high dropout rate, fewer patients experienced a “moderate” outcome, and more patients experienced a “poor” outcome; however, the effect sizes were small. Furthermore, the effects were also small and more favourable for specific functioning measures, as opposed to more global measures, small to moderate in terms of worse outcomes for follow-up periods >10 years, small to moderate for more unfavourable outcomes in males, and small to large for worse outcomes in studies including patients diagnosed before 1970.

Conclusions

In contrast to the adult manifestation, the early manifestation of schizophrenia in childhood and adolescence still carries a particularly poor prognosis. According to these aggregated data analyses, longer follow-up periods, male sex, and patients having been diagnosed before 1970 contribute predominantly to the rather poor course of EOS.

Keywords:
Early onset schizophrenia; Childhood onset schizophrenia; Long-term course; Outcome; Prognosis