Screening for Childhood-Onset Psychotic Disorders

Up to 250 children and adolescents ages 5 to 18, meeting DSM IV criteria for schizophrenia,
schizoaffective disorder, and psychotic disorder not otherwise specified, are currently under
study in our group. The purpose of this protocol is to allow systematic outpatient, and
subsequent inpatient, screening evaluation to establish an accurate diagnosis for research,
obtain clinical and neurobiological research measurements, evaluate the patient s response to
open treatment with antipsychotic(s), and allow longitudinal follow-up. Subjects and
first-degree relatives may then be enrolled in Protocol 89-M-0006, Brain Imaging of Childhood
Onset Psychiatric Disorders, Endocrine Disorders and Healthy Controls, and Protocol
84-M-0050, Biochemical, Physiological, and Psychological Measures in Normal Controls and
Relatives of Psychiatric Patients. If additional research protocols are available, this
screening protocol will represent an entry point for them.

The evaluation process will include a one-day outpatient psychiatric screening interview with
proband and family. If it is thought that the child is likely to meet criteria for childhood
onset psychoses, an inpatient evaluation will then be offered for clarifying the diagnosis.
This may involve: 1) Up to 3 weeks of inpatient observation on the child s current medication
regimen. 2) Tapering of psychotropic medications (1-4 weeks, depending upon type and dosage).
3) Observation for up to 3 weeks drug free, in order to confirm the diagnosis, and 4) Once
the diagnosis is confirmed, two to ten weeks of treatment with antipsychotic(s); 5) Discharge
to the care of his/her community psychiatrist. Treatment will be guided by what is considered
the subject s best clinical interest. During the inpatient stay, or occasionally as part of
the outpatient screening, we will obtain neurocognitive testing, research blood draws
including blood for genetic testing of the proband, and a research brain MRI scan. A skin
biopsy may be obtained either during the inpatient stay or a follow up visit.

This protocol also includes a study 100 non-schizophrenic children ages 6-13 with psychotic
symptoms (e.g. hallucinations or delusions) to extend our studies of early
neuro-developmental biomarkers and of the factors that either promote or stop the progression
to full schizophrenia (resilience or conversion factors). These children will be recruited
from the local community, evaluated as outpatients and followed prospectively for five years.
Measures will include diagnostic interviews, clinical ratings, neurocognitive testing,
anatomic and functional imaging, and blood for routine and genetic testing.

- INCLUSION CRITERIA:

- Males and females between the ages of 5 and 18

- Onset of psychotic symptoms before 13th birthday and a presumptive diagnosis of either
schizophrenia, schizoaffective disorder, MDI syndrome, or psychosis NOS

- Pre-psychotic IQ 70 or above.

EXCLUSION CRITERIA:

-Major neurological or medical condition (e.g. temporal lobe epilepsy for which patient is
on active treatment), or other psychiatric diagnosis that is the main focus of treatment
(e.g. serious eating disorder).