Early developmental abnormalities — risk for what?
The pathological process that leads to adult onset schizophrenia can be traced back to childhood in a substantial number of cases and this appears not to be restricted to cases with early onset. Brodaty (1999) reported a similar finding for schizophrenia with onset after the age of 50. This position emerges from quite different disciplines included epidemiological, neuropathological, structural brain imaging and neuropsychological studies of schizophrenia. In addition, the phenomenology and epidemiology of child onset schizophrenia strongly indicate that it is the same illness as adult-onset schizophrenia albeit with a much earlier age of onset (Asarnow and Tompson 1999; Nicolson et al. 2003; Asarnow et al. 2001). Thus theories about the aetiology and pathology of schizophrenia have started to embrace the discipline of developmental psychopathology, in which most theories about causality are complex, and dynamic rather than simple and deterministic (e.g. Sroufe 1997; Cicchetti and Cannon 1999; Kagan 1992; Harrington 2001). Initiating aetiological factors (e.g. genetic predisposition, obstetric complications etc.) might then offer a low risk for specific adult psychopathology, but high risk for a range of psy-chopathologies, since other causal factors tilt the developmental trajectory toward (i.e. increase risk), or away from (i.e. protective factors) a particular endpoint. I will argue here that evidence from cohort studies suggest that adult schizophrenia may well be an endpoint of one trajectory but other trajectories can occur given the same childhood risk factors.
KeywordsPersonality Disorder Pervasive Developmental Disorder Neurological Soft Sign Affective Psychosis Schizophreniform Disorder
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