Schizophrenia, Child and Adolescent Psychiatry

This 308-page, softcover book is packed with useful information for those interested in early- and adolescent-onset schizophrenia. It is one of a series of texts produced by Cambridge University Press as part of the Cambridge Child and Adolescent Psychiatry series. The text first describes the historical background and general characteristics of early- and adolescent-onset schizophrenia. It then reviews the etiology, natural history, and treatment of schizophrenia in children and adolescents.

Overall, the layout is clear and readable, although some of the tables related to antipsychotics are cluttered and take time to interpret. The book is well written, but there are occasional production errors indicating the need for editorial fine tuning.

The first chapter deals with the history of the classification, diagnosis, and treatment of schizophrenia in children and adolescents, from before 1900 to the present day. It reviews historical information, but at times it is confusing, because it uses varying terminology to describe similar disorders. However, this perhaps illustrates the general nosological confusion inherent in diagnosing this disorder as our understanding of it has changed over the years.

The second chapter repeats the attempt to describe the disorder’s early history. The general classification system, outlined in figure format, is somewhat vague, using old terminology as well as age ranges and symptom descriptions that are inconsistent with subsequent chapters. ICD-10 and DSM-IV criteria for schizophrenia are summarized and compared.

Chapter 3 offers a useful summary of the epidemiology of childhood- and adolescent-onset schizophrenia, Asperger’s syndrome, autism, Rett’s syndrome, and childhood disintegrative disorder. Throughout the book, the definition of very early-onset, early-onset, and adolescent-onset schizophrenia changes according to the author and the sources reviewed. This could confuse the neophyte reading this literature for the first time.

Chapter 4 is an excellent comparative review of the differing clinical picture presented in children, adolescents, and adults. By taking a developmental perspective, the author allows readers to focus on clinical characteristics that may occur at different ages. Again, there are some inconsistencies from chapter to chapter: some authors report more negative symptoms in children, and others report less. This likely reflects the lack of rigorous research design and the inclusion of disorders other than schizophrenia in earlier studies in children and adolescents.

Chapter 5 is an excellent chapter that incorporates the principles of clinical epidemiology; namely, sensitivity, specificity, and positive predictive value as it applies

to generating relevant differential diagnoses. In addition, there is an excellent review of the diagnostic and symptom rating scales found to be useful in assessing and treating children and adolescents. This would be particularly valuable to those planning research pro- jects with this age group. The chapter also addresses the clinically valuable issues of differential diagnosis, developmental variability of symptoms, and strategies for assessing psychosis in children.

Chapter 6 is a comparative review of available studies looking at family, adoption, twin, linkage, and association data across the age range, while the subsequent chapter reviews data from an ongoing UCLA genetic and family study of children with schizophrenia. It focuses on identifying neurobehavioural, cognitive, and neuropsychological deficits in children with schizophrenia and attempts to link specific processing deficits to elements of formal thought disorder. Neuroanatomical and neurobiological abnormalities are also correlated with neuropsychological deficits.

Chapter 8 reviews the literature on psychosocial influences and treatments of schizophrenia in children and adolescents and compares this to existing data for adults. In particular, the chapter looks at the data pertaining to individual and family psychotherapy, as well as skills-building models. Due to the lack of data relating specifically to children and adolescents, coverage of this area tends to be somewhat generalized.

Chapter 9 examines a broad range of treatment options, including pharmacologic interventions, electroconvulsive therapy, group therapy, and family-oriented interventions; it also gives an example of a rehabilitation program offered in Germany. The section on antipsychotics is thorough, offering definitions of atypicality and typicality, side effects, and receptor-binding profiles. Again, due to the lack of randomized controlled trials of atypical antipsychotic use in children and adolescents, recommendations are often general, based on clinical experience, and skewed toward the use of typical agents. The final chapter examines the outcome literature for studies in children, adolescents, and adults. The author compares child, adolescent, and adult data on premorbid function, onset, course of illness, and outcome.

Despite minor repetitions and occasional inconsistencies and grammatical errors, this well-rounded book makes an excellent attempt to pull the often confusing and contradictory body of literature on childhood and adolescent psychosis into the 21st century. The contributions from international sources offer a more global view of this illness and the interventions used to treat it. The book is well worth the reader’s investment of time and money.