Frühentwicklung kindlicher Schizophrenien

Zusammenfassung

Knapp 60 % der von uns untersuchten Patienten mit einer kindlichen Schizophrenie (Erkrankungsbeginn zwischen 7 und 14 Jahren) zeigten bereits prämorbid Auffälligkeiten ihrer emotionalen und sozialen Entwicklung. Es bestand eine signifikante Korrelation zwischen hohen M-PAS-Scores einerseits und frühem Erkrankungsalter, schleichendem Beginn und Negativ-Symptomatik andererseits. Hohe M-PAS-Werte korrelierten positiv mit der Dauer psychotischer und residualer Zustände, sie erwiesen sich als prognostisch ungünstig. Für die Ausprägung psychosozialer Entwicklungsauffälligkeiten sind sowohl genetische Faktoren als auch gestörte Eltern-Kind-Beziehungen verantwortlich zu machen. Unter präventiven Gesichtspunkten ist es sinnvoll, möglichst frühzeitig und behutsam entsprechende Risikogruppen zu erfassen, in regelmäßigen Abständen zu untersuchen und ihnen therapeutische Angebote zu machen (familiäres Krisenmanagement, Erarbeitung adäquater Stressbewältigungs- und Konfliktlösungsstrategien, Erkennen von Frühwarnzeichen).

Abstract

Childhood-onset schizophrenia (COS, age of onset between 7 and 14 years) is a rare and severe form of the disorder. The prevalence is about 1 / 50 of the rate of adult-onset schizophrenia. In COS-children emotional, cognitive and behavioural abnormalities are often seen years before illness onset. Premorbid symptoms including social withdrawal, isolation, introversion, peculiar behaviour, unmotivated temper tantrums, auto- and heteroaggressive acts, suicidal thoughts, anxiousness, paranoid ideas, represent early warning symptoms and are associated with an unfavourable outcome. About 60 % of 67 patients with COS examined by us (44 long-term-, 23 short-term-follow-up examinations) demonstrated premorbid abnormalities prior to the onset of their psychosis. We found a significant correlation between high M-PAS-scores, insidious onset, negative PANSS-Items, and early onset of age (< 12 years). High M-PAS-Scores were positively related to long duration of psychotic and residual states, and vice versa there was a negative correlation between M-PAS and a favourable outcome (long duration of recovery states). It is necessary to identify clinical states of elevated risk for psychosis as early as possible. This is difficult especially in young patients, in whom psychical peculiarities are ambiguous, and they may develop in different directions, most of them into normalization. Nevertheless, it is important to recognize risk-groups by time and to study their development carefully. Thus they could benefit from multiprofessional family-oriented early interventions.

Schlüsselwörter

Frühwarnzeichen - prämorbide Symptome - Prodrome - Risikofaktoren - Frühbehandlung

Key words

childhood-onset schizophrenia - premorbid functioning - prodromal states - risk factors - early intervention

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