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Incidence and 12-month outcome of childhood non-affective psychoses: British national surveillance study

  • Paul A. Tiffin (a1) and Charlotte E. W. Kitchen (a1)

Summary

The schizophrenias are uncommon before the age of 14 but incidence/prevalence figures are lacking. The 1-year incidence, clinical features and short-term outcomes in childhood-onset schizophrenia spectrum disorder were evaluated via the Child and Adolescent Psychiatry Surveillance System. Fifteen children with a provisional diagnosis were reported. Outcome data were obtained for 12 individuals, 8 of whom met the diagnostic criteria, equating to an estimated incidence of 0.21/100 000 (95% CI 0.08–0.34). Delusions and thought disorder were a more consistent predictor of ‘caseness' than hallucinations. Illness outcomes at 1 year were generally poor. Childhood-onset schizophrenia appears to be a rare but serious disorder.

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Copyright

Corresponding author

Paul A. Tiffin, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, Stockton-on-Tees TS17 6BH, UK. Email: p.a.tiffin@dur.ac.uk

Footnotes

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Declaration of interest

None.

Footnotes

References

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1 Hafner, H, Maurer, K, Loffler, W, Fatkenheuer, B, an der Heiden, W, Riecher-Rossler, A, et al. The epidemiology of early schizophrenia. Influence of age and gender on onset and early course. Br J Psychiatry 1994; 164 (suppl 23): 2938.
2 Nicolson, R, Lenane, M, Hamburger, SD, Fernandez, T, Bedwell, J, Rapoport, JL. Lessons from childhood-onset schizophrenia. Brain Res Rev 2000; 31: 147–56.
3 Childs, B, Scriver, CR. Age at onset and causes of disease. Perspect Biol Med 1986; 29: 437–60.
4 Eggers, C. Course and prognosis of childhood schizophrenia. J Autism Child Schizophr 1978; 8: 2136.
5 Eggers, C, Bunk, D, Ropcke, B. Childhood and adolescent onset schizophrenia: results from two long-term follow-up studies. Neurol Psychiatry Brain Res 2002; 9: 183–90.
6 Padgett, FE, Miltsiou, E, Tiffin, PA. The co-occurrence of nonaffective psychosis and the pervasive developmental disorders: a systematic review. J Intellect Dev Disabil 2010; 35: 187–98.
7 Rapoport, J, Chavez, A, Greenstein, D, Addington, A, Gogtay, N. Autism spectrum disorders and childhood-onset schizophrenia: clinical and biological contributions to a relation revisited. J Am Acad Child Adolesc Psychiatry 2009; 48: 10–8.
8 National Institute for Mental Health. Childhood-Onset Schizophrenia Study. NIMH, 2014 (http://www.nimh.nih.gov/labs-at-nimh/research-areas/clinics-and-labs/chp/childhood-onset-schizophrenia-study.shtml).
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12 Guy, W. ECDEU Assessment Manual for Psychopharmacology. US Department of Health, Education and Welfare, 1976.

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Incidence and 12-month outcome of childhood non-affective psychoses: British national surveillance study

  • Paul A. Tiffin (a1) and Charlotte E. W. Kitchen (a1)
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eLetters

RE: Incidence and 12-month outcome of childhood non-affective psychoses: British national surveillance study

Vishal Bhavsar, Epidemiologist, Institute of Psychiatry
22 March 2015

Dear Sir,

The epidemiology of psychosis in children is a story of even smaller numbers than for psychosis in grown-ups. But how much smaller? The short report of Tiffin and Kitchen on incident cases of schizophrenia in children in 2010-2011 is a well-needed addition to a limited descriptive literature on psychosis in children. I have a couple of points about the analysis, which I feel might clarify the report.

The authors point out at the outset the heuristic that earlier onset cases of a disorder might have a "greater loading of causal factors". This does not seem to be correct- all cases of a given disorder represent the interrelation of a number of risk factors on a causal pathway- it is therefore unclear why earlier cases would represent the culmination of pathways with a greater number of causal factors. The authors may mean that earlier onset psychoses could represent individuals with stronger risk factors for the disorder. However, although this is usually correct for diseases in general, this point rests on the assumption that that there is a single underlying outcome under study, which has long been contested(2). Assuming this heterogeneity is related in some way to the clinical heterogeneity of schizophrenia across people of different ages and with different risk factor patterns, this may explain the large number of false positives identified in Tiffin and Kitchen's study.

Secondly, although the authors present confidence intervals(presumably based on Poisson standard errors), it is important to point out what the intervals are referring to- this study attempts to capture all cases within a surveillance approach, rather than to sample the target population. In this case, the confidence intervals refer to the underlying randomness of the disease process, rather than to the design of the study(3). Confidence intervals used in this way are not meaningless, however they may not be strictly necessary here- it seems that reporting the crude rate in this type of study is an almost equally informative approach for the purposes of this research. Furthermore, uncertainty about the true rate of the disorder due to random variability("error") in the disease process likely pales in comparison to the systematic error introduced by biases in this design.

1.Tiffin, P. A., & Kitchen, C. E. (2015). Incidence and 12-month outcome of childhood non-affective psychoses: British national surveillance study. Br J Psychiatry. doi: 10.1192/bjp.bp.114.158493

2. Tsuang, M. T., Lyons, M. J., & Faraone, S. V. (1990). Heterogeneity of schizophrenia. Conceptual models and analytic strategies. The British Journal of Psychiatry, 156(1), 17-26.

3. Eayres D. APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. http://www.apho.org.uk/resource/view.aspx?RID=48457 (accessed 22 Mar 2015).

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