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Childhood-onset schizophrenia: insights from neuroimaging studies.

Advances in neuroimaging allow prospective study of human brain development. Studies on pediatric populations are particularly informative because they explore the pathophysiological processes that are tied to important periods of brain development. Furthermore, childhood-onset counterparts of typical adult-onset illnesses usually show a more severe phenotype, one that is less likely to be influenced by environmental factors and more likely to show genetic influences. Such samples thus provide an opportunity to study the illness in its relatively pure form and that may also increase the likelihood of identifying causal genetic events. A study of childhood-onset schizophrenia (COS) has been ongoing at the NIMH since 1990. The diagnosis is made using unmodified DSM-III-R/IV criteria and, in most cases, after a drug-free inpatient observation. The COS cases (N = 102 to date) clinically resemble poor outcome adult-onset schizophrenia (AOS) cases, in that all phenomenological, family, and neurobiological studies in COS show similar findings as in AOS, suggesting continuity between these two forms of the illness. Structuralbrainabnormalitiesareanestablishedfeature of AOS, characterized by reduced gray matter (GM) volumes in the cortex, hippocampus, and amygdala, which is subtly progressive over time. The majority of neuroimaging studies in COS have come from the NIMH sample. Earlier COS studies, consistent with findings from AOS studies, showed increased lateral ventricular volume, decreased total and regional GM volumes, and increased basal ganglia volumes that progressed during adolescence.