Functional outcome in childhood-onset schizophrenia in Nigeria: a 3-year longitudinal study Musa U. Umar, Shehu Sale Department of Psychiatry, Child and Adolescent Mental Health Unit, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria Correspondence to Musa Usman Umar, MBBS, FWACP, Department of Psychiatry, Child and Adolescent Mental Health Unit, Aminu Kano Teaching Hospital, Bayero University, Zaria Road, PMB 3452, 77189 UNIBAYERO NG, Kano, Nigeria, Tel: +234 803 660 5552; e-mail: sophiee87@yahoo.com Received 11 February 2016 Accepted 1 May 2016 Egyptian Journal of Psychiatry 2016, 37:118–124 Background The outcome of childhood-onset schizophrenia (COS) is generally regarded as poor. Few prospective studies have been reported from developing countries. Aim The aim of the present study was to assess the functional outcome in COS and the factors associated with poor outcome. Methods This 3-year prospective study included 19 patients with COS. Diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., criteria using the Kiddie-Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version; severity was assessed through the Positive and Negative Symptoms Scale, whereas the measure of outcome used was Children’s Global Assessment Scale. Results The mean duration of follow-up was 39.53 (SD ±5.37) months. The mean age of onset of COS was 10.47 (SD ±0.91) years. At the end of the study, 31.6% of the participants had good outcome, 42.1% had moderate outcome, and 26.3% had poor outcome. Factors associated with poor outcome included history of perinatal complication, more negative symptoms, and longer duration of untreated psychosis. Conclusion More than a third of the sample showed good outcome over the few years of follow- up. On the basis of the findings of this study, we recommend an early intervention. Keywords: childhood-onset schizophrenia, functional outcome, prospective follow-up study Egypt J Psychiatr 37:118–124 © 2016 Egyptian Journal of Psychiatry 1110-1105 Introduction Schizophrenia most commonly emerges during late teens and early adulthood, but it can also be diagnosed during childhood (American Psychiatric Association, 2013). Childhood-onset schizophrenia (COS) is a severe form of psychotic disorder that occurs at the age of 13 years or younger and is often chronic and persistently debilitating (Remschmidt et al., 2007). It is a severe form of the late adolescent and early adult-onset disorder (Rapoport and Inoff-Germain, 2000). COS is a rare disorder; in preadolescents, the estimated prevalence is less than one case per 10 000 (Asarnow et al., 2004). The number of new cases significantly increase during late adolescence, reaching an approximate prevalence of 1% for later-onset schizophrenia. It occurs more in males unlike the adult-onset type that has equal ratio. Individuals with COS present with more premorbid impairment than do those with late-onset, with an increased prevalence of genetic abnormalities (Addington and Rapoport, 2009). A clinical and outcome study by Hassan and Taha (2011) reported that about 24% of patients with early-onset schizophrenia had good outcome, and that premorbid adjustment, intelligence quotient, negative symptoms, and gradual onset were associated with poor outcome. In a recent systematic review, good outcome for early-onset schizophrenia was 15.4%, with male sex and longer follow-up periods as predictors of poor outcome (Clemmensen et al., 2012). Most studies around the world have reported poor prognosis for COS (Jarbin and von Knorring, 2003; Gonthier and Lyon, 2004; Röpcke and Eggers, 2005; Remschmidt et al., 2007), although a recent meta-analysis reported better outcome in patients with early-onset schizophrenia compared with the adult- onset group (Amminger et al., 2011). Because COS is a rare disorder, it is poorly understood and has not received adequate attention from researchers (Bartlett, 2004; Clemmensen et al., 2012). It is This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms. 118 Original article © 2016 Egyptian Journal of Psychiatry | Published by Wolters Kluwer - Medknow DOI: 10.4103/1110-1105.195549 [Downloaded free from http://www.new.ejpsy.eg.net on Tuesday, December 13, 2016, IP: 197.211.56.29]