Behavioural disturbances and psychopathology

What are antecedents of schizophrenia?

Antecedents such as behavioural disturbances and psychopathology are subtle deviations in development that may become evident during childhood or adolescence. The presence of these deviations may foreshadow the later development of schizophrenia, however most children who exhibit these antecedents do not develop the disorder. Studies exploring antecedents are ideally based on representative, population-based samples that follow the group from birth through childhood and adolescence to adulthood. These studies can provide unique insights into the changes in developmental trajectories that may be associated with schizophrenia.

What is the evidence for behavioural disturbances and psychopathology as antecedents of schizophrenia?

Overall, moderate quality evidence suggests schizophrenia may be associated with a range of behavioural problems and psychopathology during childhood and early adolescence. These behavioural antecedents are subtle; individuals who later develop schizophrenia are not marked by extreme deviations in behaviours and most children who exhibit these disturbances do not develop schizophrenia. Possible behavioural disturbances include ADHD, social anxiety, social maladjustment, deviant behaviour, psychotic-like experiences, delusions, hallucinations, and general psychopathology.

The prevalence of psychotic-like experiences in children and adolescents is around 10%. Prevalence is higher in cross-sectional studies than in longitudinal studies, and in studies using questionnaires rather than interviews. Children and adolescents who report psychotic experiences had a medium-sized increased risk of later developing a psychotic disorder, or any other mental illness.

The prevalence of hallucinatory experiences in children aged between 7 and 18 years is between 5% and 9%. The odds of transitioning to a psychotic disorder are higher for children who have experienced hallucinatory experiences than for children who have not experienced hallucinatory experiences.

From age 3 years, higher levels of social withdrawal may be apparent. This is not specific to schizophrenia as it is also related to later development of depression, anxiety, neurosis, and mania. In adolescence, poor social functioning may be a specific predictor for a psychotic disorder. From age 3 to 6 years, higher levels of externalising behaviour may be evident, including aggression, bullying, disruptiveness, and noncompliance with adults. Higher levels of over-reactive behaviours may be apparent from age 7 to 12 years in males. From age 13 to 17 years, higher levels of disagreeableness and disruptiveness may be apparent, with no increase in aggressiveness or negative attitudes. Antisocial-externalising behaviour in preschool, childhood, and in high-risk adolescents may be a specific predictor of schizophrenia, although specificity does not extend to comparisons with mania.

March 2022

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Last updated at: 3:12 pm, 29th March 2022
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