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Childhood-Onset Schizophrenia:

Structural Brain Abnormalities

 Courtney Dawson

 Penn State College of Medicine



Basic information regarding childhood-onset schizophrenia (COS):

  • Onset of psychosis by age 12 (2)
  • Rare à 1/50 the prevalence of later-onset disease (1)
  • Insidious rather than episodic onset (7)
  • Continuing severe illness in about ½ of the cases (7)
  • Psychotic symptomatology prior to the completion of normal brain maturation (9)


A retrospective study (17 subjects) conducted at the University of Colorado looked at premorbid and prodromal diagnostic features of COS (8):

  • 65% reported problems is school as the initial symptom
  • 59% reported 1st sign of psychotic symptoms between 5-10 years of age
  • Average age of 1st clinical diagnosis of COS or schizoaffective disorder reported as 10.5 years of age
  • Significant lag time between initial symptoms and a concrete clinical diagnosis


Neurodevelopmental Hypothesis of Schizophrenia: Brain “lesion” is present early in life but does not manifest itself until late in adolescence or early adulthood (6)


Underlying brain pathology presents differently at different ages:

  • 1) Global delays in motor and possibly language development
  • 2) Nonspecific attentional and behavioral dysfunction
  • 3) Clinically identifiable thought disorder
  • 4) Development of the full clinical syndrome as the brain matures


COS subjects had an increased incidence of speech and motor abnormalities prior to the onset of psychosis à possible indication of earlier brain developmental abnormalities


Current research focused on structural changes in COS: (9)

  • Most of the research has been conducted by Rapoport and colleagues at the National Institute of Mental Health, most are prospective studies involving 15-75 COS subjects with initial MRI scans and follow-up scans at 2-year intervals
  • General trend: progressive age-related changes reach an asymptote as subjects reach late adolescence or adulthood
  • Add to previous evidence for abnormal postnatal brain development in schizophrenia


Structural Brain Abnormalities and Clinical Correlates:

1) Total cerebral volume: 9.2% ¯ with COS (1) compared to 3% ¯ in adult-onset patients (9)à indicates that COS patients are more severely affected than their adult-onset counterparts


2) Lateral Ventricular volume: progressive ­ with an ­ ventricular brain ratio (1)à correlated to ­ Premorbid Assessment Scale scores (7) and Brief Psychiatric Rating Scale scores at follow-up


3) Cortical gray matter volume: 8% ¯ with COS compared to 1.98% ¯ in healthy controls (6)à rate of loss correlated to ­ baseline Brief Psychiatric Rating Scale scores, follows a back-to-front “wave” pattern


4) Midline thalamus volume: 17.2% ¯ with COS (1)à might explain complex symptoms involved in the psychotic process of schizophrenia, given the role of the thalamus in filtering sensory input


5) Cerebellar volume: progressive ¯ during adolescence (4) , developmental trajectories differ from controlsà possible relationship to impaired executive function and working memory, but NIMH study failed to find a correlation


6) Basal ganglia volume: progressive ­ in caudate, putamen, and globus pallidus volumes (1)à globus pallidus volume ­ may be related to neuroleptic exposure    


7) Corpus callosum volume: focal ¯ in the splenium (posterior region) compared to a generalized volume ­ as expected in this age group (5)à may be related to posterior gray matter changes in schizophrenia


8) Hippocampal volume: progressive ¯ (2)à correlated to Scale for Assessment of Positive Symptoms scores


Could there be a genetic trait marker for COS?

 A prospective study conducted at the NIMH looked at structural brain abnormalities in healthy siblings of patients with COS (3):

  • 15 full siblings of COS patients, 32 matched healthy volunteers
  • Healthy siblings of COS probands have ¯ total and parietal gray matter volumes than controls
  • No significant difference in white matter volumes
  • No ventricular enlargement seen in siblings
  • In families with a member who has schizophrenia, familial or genetic factors may contribute to shared structural brain abnormalities


Future research opportunities:

  • Adolescence is a unique window of opportunity to study structural brain changes in this COS population
  • Must look at both early and late changes and the progressive nature of the changes





  • 1) Frazier J, Giedd J, et al. Brain Anatomic Magnetic Resonance Imaging in Childhood-Onset Schizophrenia. Arch Gen Psychiatry. 1996; 53: 617-624.


  • 2) Giedd J, Jeffries N, et al. Childhood-Onset Schizophrenia: Progressive Brain Changes during Adolescence. Biol Psychiatry. 1999; 46: 892-898.


  • 3) Gogtay N, Sporn A, et al. Structural Brain MRI Abnormalities in Healthy Siblings of Patients with Childhood-Onset Schizophrenia. Am J Psychiatry. 2003; 160: 569-571.


  • 4) Keller A, Castellanos F, et al. Progressive Loss of Cerebellar Volume in Childhood-Onset Schizophrenia. Am J Psychiatry. 2003; 160: 128-133.


  • 5) Keller A, Jeffries N, et al. Corpus callosum development in childhood-onset schizophrenia. Schizophrenia Research. 2003; 62: 105-114.


  • 6) Rapoport J, Giedd J, et al. Progressive Cortical Change During Adolescence in Childhood-Onset Schizophrenia: A Longitudinal Magnetic Resonance Imaging Study. Arch Gen Psychiatry. 1999; 56: 649-654.


  • 7) Rapoport J, Giedd J, et al. Childhood-Onset Schizophrenia: Progressive Ventricular Change During Adolescence. Arch Gen Psychiatry. 1997; 54: 897-903.


  • 8) Schaeffer J, Ross R. Childhood-Onset Schizophrenia: Premorbid and Prodromal Diagnostic and Treatment Histories. J Am Acad Child Adolesc Psychiatry. 2002; 41: 538-545.


  • 9) Sowell E, Toga A, Asarnow R. Brain Abnormalities Observed in Childhood-Onset Schizophrenia: A Review of the Structural Magnetic Resonance Imaging Literature. Mental Retardation and Developmental Disabilities Research Reviews. 2000; 6: 180-185.
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