Psychotic disorders in children are more heterogeneous than is captured by categorical diagnoses. In a new cohort of children and adolescents, we evaluated the relationships among age at onset (AAO), clinical symptoms and developmental impairments. Patients with schizophrenia and other "spectrum" psychotic diagnoses (N = 88; AAO 6-17, mean 12.6) were evaluated with diagnostic interviews, a new clinical scale (Lifetime Dimensions of Psychosis Scale-Child and Adolescent), and neuropsychological and medical evaluations. Key findings were replicated in an adult cohort of 2420 cases, including 127 with retrospective AAO<13. Factor and cluster analyses were carried out to identify clinical profiles. Five clinical factors were identified in each cohort: Positive, Bizarre Positive, Negative/Formal Thought Disorder, Depression and Mania. Earlier AAO predicted severity of bizarre positive symptoms in children and of bizarre and other symptoms in adults. Four clinical clusters in the child cohort were characterized by: more severe bizarre positive symptoms (N = 31); negative symptoms (N = 15); premorbid autism spectrum features and developmental delay (N = 12); and depressive symptoms with heterogeneous diagnoses and mild positive/negative symptoms (N = 25). Previous factor-analytic studies of childhood psychosis did not specifically consider bizarre positive symptoms. Here, bizarre positive symptoms emerged as clinical markers of severe, childhood-onset psychosis similar to adult schizophrenia. The four clusters are clinically meaningful and useful for treatment planning and potentially for biological research. Childhood-onset cases are rare and thus difficult to study, but additional, larger cohorts may be useful in dissecting the biological and developmental heterogeneity of psychotic disorders.

中文翻译：

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早发性精神病的发育和症状特征

儿童精神障碍的异质性比分类诊断所捕获的更具异质性。在一个新的儿童和青少年队列中，我们评估了发病年龄 (AAO)、临床症状和发育障碍之间的关系。精神分裂症和其他“谱系”精神病诊断患者（N = 88；AAO 6-17，平均 12.6）通过诊断访谈、新的临床量表（精神病的终生量表 - 儿童和青少年）以及神经心理学和医学评估进行评估. 主要发现在 2420 例成人队列中得到复制，其中 127 例回顾性 AAO<13。进行因子和聚类分析以确定临床特征。在每个队列中确定了五个临床因素：积极、异常积极、消极/正式思维障碍、抑郁和躁狂症。早期的 AAO 预测了儿童奇异阳性症状和成人奇异和其他症状的严重程度。儿童队列中的四个临床集群的特点是： 更严重的奇异阳性症状（N = 31）；阴性症状（N = 15）；病前自闭症谱系特征和发育迟缓（N = 12）；和具有异质性诊断和轻度阳性/阴性症状的抑郁症状（N = 25）。先前对儿童精神病的因素分析研究并未专门考虑奇异的阳性症状。在这里，奇怪的阳性症状出现作为类似于成人精神分裂症的严重儿童期精神病的临床标志。这四个集群具有临床意义，可用于治疗计划和潜在的生物学研究。儿童发病的病例很少，因此难以研究，