Harvard Researcher at Cambridge Health Alliance Publishes Landmark Study

Study Title: Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS): Demographic and Clinical Characteristics.

Study Summary: The authors reported baseline demographic and clinical profiles of youths enrolled from 2001 to 2006 in the Treatment of Early-Onset Schizophrenia Spectrum Disorders Study, a National Institute of Mental Health funded, multi-center, randomized, and controlled trial. The data from this study expand the available information regarding patterns of psychopathology and functional impairment associated with early-onset schizophrenia spectrum disorders.

Background: Early-onset schizophrenia spectrum disorders (EOSSs), defined as having schizophrenia, schizoaffective disorder, and schizophreniform disorder with onset before age 18, are disabling conditions characterized by psychotic symptoms, inappropriate affect, abnormal cognition, and social withdrawal. Children and adolescents are diagnosed with these disorders using the same criteria as those for adults. Making a diagnosis of a psychotic disorder in youths can be difficult due to the fact that other psychiatric disorders of childhood and adolescence have symptoms that overlap with those of EOSSs.

Methods: Youths (between the ages of 8-19) with schizophrenia spectrum disorders were recruited at four academic sites. Diagnoses were made via structured and clinical interviews. The data collected assessed the demographic, clinical presentation and social and global functioning of these children and adolescents. In addition, the symptomatic and functional differences between schizophrenia and schizoaffective disorder were evaluated. Finally, the profile of the overall sample was compared to data reported in studies of adults with schizophrenia to assess how youths with schizophrenia spectrum disorders are similar to or different from adults with the disorder.

Findings: This study is one of the largest samples of youths with schizophrenia spectrum disorders studied to date, including 119 individuals, and the largest assessment of youths with schizoaffective disorder. High rates of symptoms and general psychopathology were noted, as was a substantial degree of social and functional impairment. The symptom profiles are consistent with, but more severe than, those reported in adult cases.

Impact: The data from this study highlights the critical importance of a thorough evaluation by clinicians well-trained in identifying early-onset psychosis. A systematic approach toward diagnostic assessment and treatment monitoring will lead to a more timely initiation of appropriate treatment, better identification of risk factors and safety concerns, and improved outcomes. The results also show that youths with schizophrenia and youths with schizoaffective disorder exhibit many similar symptoms, emphasizing the importance of recognizing EOSSs rather than distinguishing between the two disorders.

Terms: Schizophrenia is a mental illness in which the subject suffers from distorted thinking, hallucinations, and a reduced ability to feel normal emotions. Schizoaffective disorder is a mental illness where both the symptoms of mood disorder and psychosis are present. Schizophreniform disorder is a mental disorder with the signs and symptoms of schizophrenia but duration of less than 6 months.

Authors: This study is a collaboration between four sites: Cambridge Health Alliance, University of North Carolina at Chapel Hill (UNC), the University of Washington, and Case Western Reserve University. The lead author is Jean A. Frazier, MD, Director of the Child and Adolescent Neuropsychiatric Research Program at Cambridge Health Alliance and Associate Professor of Psychiatry at Harvard Medical School. In addition to Dr. Frazier, Joseph A. Jackson, DO, Benjamin Zablotsky, BA, and Nancy Noyes, MS, CN, CPNP, are with Cambridge Health Alliance, Harvard Medical School. The other authors include: Jack McClellan, MD, Stefanie A. Hlastala, PhD, Leslie Pierson, MPH, and Jennifer A. Varley, BA, who are with the University of Washington, Seattle; Robert L. Findling, MD, and Nora K. McNamara, MD, are with Case Western Reserve University, Cleveland; Benedetto Vitiello, MD, and Louise Ritz, MBA, who are with the National Institute of Mental Health, Bethesda, MD; Ann E. Maloney, MD, who is with the Maine Medical Center, Portland; Tyehimba Hunt-Harrison, MD who is with the John Umstead Hospital, Butner, NC; Jeffrey A. Lieberman, MD, who is with Columbia University, New York; and Linmarie Sikich, MD, Robert M. Hamer, PhD, Denisse Ambler, MD, Emily Williams, MEd, Madeline Puglia, BA, and Robert Anderson, BS, who are with the University of North Carolina at Chapel Hill.

Journal: Journal of the American Academy of Child and Adolescent Psychiatry: available online now at www.jaacap.com and to be published in the August 2007 print edition.

Funding: The project was supported by the National Institute of Mental Health as well as two National Institute of Health Research Career Development awards.

Cambridge Health Alliance is a regional healthcare system with three hospitals and more than twenty primary care practices in Cambridge, Somerville, and Boston's metro-North communities. As a teaching affiliate of Harvard Medical School, Cambridge Health Alliance offers medical residency/training programs and undergraduate learning experiences in hospital and community settings. Cambridge Health Alliance also includes the Cambridge Public Health Department, CHA Physician's Organization (CHAPO), and Network Health, a managed Medicaid and Commonwealth Care plan.