Childhood clues to schizophrenia.

Schizophrenia, a severe mental disorder that afflicts about 1 in 100 people, usually emerges in late adolescence or young adulthood. Its symptoms run a frightening gamut that includes hearing the taunts of imaginary voices, becoming convinced that others control one's thoughts, losing the will to work or maintain relations with loved ones, and laughing or crying uncontrollably at inappropriate times.

In rare cases, children exhibit clear signs of schizophrenia. Two preliminary investigations of such youngsters, both published in the January American Journal of Psychiatry, suggest that childhood schizophrenia bears similarities to the adult version, but it stems from a more severe brain disruption. Moreover, continued research into the biological changes underlying childhood schizophrenia may help to identify subtler disturbances at work in adult victims of the disorder.

The first study, directed by Javad Alaghband-Rad, a psychiatrist at the National Institute of Mental Health (NIMH) in Bethesda, Md., finds that some of the most severe and intractable symptoms of schizophrenia-such as a deadening sense of apathy and social withdrawal-appear in the youngsters displaying the smallest brains, as measured by a brain-scanning device. A couple of prior studies uncovered the same pattern in adults with schizophrenia, "but our data show a more striking relationship," according to the researchers.

Small brain size may create a vulnerability to a number of mental disorders, which then combine with disturbances of brain development specific to schizophrenia, they propose. The study consisted of 29 volunteers age 10 to 19, all of whom had been diagnosed with schizophrenia before age 12. In a second investigation by the same group, directed by NIMH psychiatrist Leslie K. Jacobsen, treatment with antipsychotic medications produced comparable improvement in 18 teenagers whose schizophrenia began in childhood and in 16 adults whose schizophrenia first appeared later in life. The course of treatment with each of the two drugs-haloperidol and clozapine-lasted for 6 weeks. Brain chemistry remained largely unchanged for both the teens and adults after treatment. So the mechanism for the drugs' action remains unclear.