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Childhood Onset of 'Adult' Psychopathology

Clinical and Research Advances

Edited by Judith L. Rapoport, M.D.
American Psychopathological Association

  • ISBN 978-0-88048-821-1
  • Item #8821

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Age at onset studies have been an important approach to understanding disease across all medical specialties. Over the last few decades, genetic research has led to the identification of unique genes and, in some cases, physiologically different disorders. These advances bring us closer to identifying genetic vulnerability and implementing prevention programs for psychopathology.

Childhood Onset of Adult Psychopathology: Clinical and Research Advances provides an understanding of the childhood onsets of adult psychiatric disorders, including when and in what sequence psychiatric disorders begin in childhood, and how these disorders evolve over the life span. This book examines

  • Studies on the growing volume of data on very early forms of depression, criminality, alcoholism, schizophrenia, and anxiety
  • Genetics, evolution, and the significance of age at onset in terms of individual variability and the course of disease
  • The biological manner in which early-onset disorders progress
  • New insights into the disease etiology of schizophrenia and the neurodevelopmental hypothesis
  • The long-debated subject of whether depressive disorder in preadolescent children is the same as depressive disorder in adults and studies of individuals at risk for disorders of anxiety and depression
  • The implications for prevention of adult psychiatric disorders, alcoholism, and antisocial personality disorder

Complete with extensive references and tables, this text provides practitioners with a better understanding of adult psychopathology and insight into early detection and prevention methods.


  • Contributors
  • Introduction
  • Part I: Age at Onset: Mechanisms and Methods
  • Chapter 1. Genetics of Early-Onset Manic-Depressive Illness and Schizophrenia
  • Chapter 2. Genetics, Evolution, and Age at Onset of Disease
  • Chapter 3. Trinucleotide Expansion in the FMR1 Gene and Fragile X Syndrome
  • Part II: Neurodevelopmental Pathways to Adult Psychiatric Disorders: Triggers of Disease Onset
  • Chapter 4. Biological Markers as Precursors to Schizophrenia: Specificity, Predictive Ability, and Etiological Significance
  • Chapter 5. PANDAS: A New Species of Childhood-Onset Obsessive-Compulsive Disorder?
  • Chapter 6. Prenatal Antecedents of Neuropsychiatric Disorder Over the Life Course: Collaborative Studies of United States Birth Cohorts
  • Part III: Schizophrenia: Specific Disorders
  • Chapter 7. Late-Onset Schizophrenia: New Insights Into Disease Etiology
  • Chapter 8. Childhood-Onset Schizophrenia: What Can It Teach Us?
  • Chapter 9. Neurodevelopmental Hypothesis of Schizophrenia 12 Years On: Data and Doubts
  • Part IV: Depression and Anxiety
  • Chapter 10. Childhood Depression: Is It the Same Disorder?
  • Chapter 11. Offspring at Risk: Early-Onset Major Depression and Anxiety Disorders Over a Decade
  • Chapter 12. When Is Onset? Investigations Into Early Developmental Stages of Anxiety and Depressive Disorders
  • Chapter 13. Very-Early-Onset Bipolar Disorder: Does It Exist?
  • Part V: Early Prevention of Adult Psychiatric Disorders
  • Chapter 14. Prevention of Mental Disorders and the Study of Developmental Psychopathology: A Natural Alliance
  • Chapter 15. Prevention of Alcoholism: Reflections of a Naturalist
  • Chapter 16. Prevention of Antisocial Personality Disorder
  • Index

About the Authors

Judith L. Rapoport, M.D. is Chief of the Child Psychiatry Branch at the National Institute of Mental Health in Bethesda, Maryland. Dr. Rapoport is a graduate of Swarthmore College and Harvard Medical school. Her clinical training was at the Massachusetts Mental Health Center, and at Children's Hospital in Washington, DC. Her research training was at the Karolinska Hospital in Stockholm and the Laboratory of Psychology at the National Institute of Mental Health (NIMH). Her research has covered several aspects of child psychiatry including diagnosis, childhood hyperactivity, pediatric psychopharmacology and author of three professional books and over two hundred research journal articles. She is currently Chief of the Child Psychiatry Branch, National Institute of Mental Health. Work in her branch on Attention Deficit Hyperactivity Disorder has recently focused on normal and abnormal brain development.

Provides the reader with an appreciation of how a developmental perspective can be employed to provide a greater overall understanding of psychopathology . . . This book is certainly recommended to clinicians who treat children and teenagers. However, because it also reviews how developmental considerations can be used to advance the understanding of psychopathology across the life cycle, it is strongly recommended to those clinicians who solely treat adults as well.—Journal of Clinical Psychiatry 62:2, 2/1/2001

The developmental perspective that dominated psychoanalytic theory was eclipsed a quarter of a century age with ascendance of phenomenologic psychiatry with its emphasis on categorical diagnosis. Childhood Onset of Adult Psychopathology edited by the eminent NIMH Child Psychiatrist, Judith Rapoport M.D., does much to redress this imbalance by focusing upon the developmental antecedents of mental illness and the clues derived from early onset of severe mental disorders. This new developmental perspective, grounded in neurobiology, emphasizes the interaction between genetic and environmental risk factors and provides scientific foundations for preventive interventions. Each chapter is written by a world renowned group of experts in covering genetic mechanisms, neurodevelopmental pathways, specific disorders and prevention.—Joseph T. Coyle, M.D., Eben S. Draper Professor of Psychiatry and of Neuroscience, Chairman, Consolidated Department of Psychiatry, Harvard Medical School, Boston, Massachusetts

Judy Rapoport, the outstanding Chief of the NIMH Child Psychiatry Branch, has put us all in her debt by assembling and editing a book on the earliest forms of psychiatric disorders resembling those seen in adults: depression, schizophrenia, anxiety, alcoholism and criminality. Are early onset cases no more than random variation of all cases around a mean age of onset? Or do they represent the influence of specific genetic or environmental factors? Might they reflect genetic anticipation (as it is seen in Fragile-X mental retardation)? The answers aren't in but the issues are thoughtfully discussed in this excellent volume. The remarkable NIMH study of childhood-onset schizophrenia, early results of which are briefly described in Dr. Rapoport's chapter, will be a landmark in psychiatry. All-in-all, this is a first-rate publication, of interest to clinicians as well as investigators.—Leon Eisenberg, M.D., Presley Professor of Social Medicine, and Professor of Psychiatry, Emeritus, Harvard Medical School, Boston, Massachusetts

Psychiatrists are trained to take a thorough history of childhood events when evaluating an adult patient, but few adult psychiatrists have a grasp of what is known about childhood precursors of adult psychiatric illness. We tend to think of depression, schizophrenia, bipolar disorder and anxiety disorders as illnesses that arise sometime after age 18 in most patients and rarely understand that the roots of many of these disorders can be found many years earlier. Understanding the ways in which childhood symptoms and predispositions merge into adult psychopathology is critical both for treatment and prevention efforts. It is precisely this understanding at which Childhood Onset of Adult Psychopathology: Clinical and Research Advances is aimed. Edited by one of the world's great scientists and clinicians, Dr. Judith Rapoport, this volume gathers a group of remarkable scientists who grapple with learning about, and teaching us, how childhood is the staging platform for many adult psychiatric disorders. This book is essential reading for all psychiatrists, whether interested in research, clinical care, or both.—Jack M. Gorman, M.D., Professor and Vice-chair for Research, Department of Psychiatry, Columbia University, New York, New York

A not-so-quiet revolution has been stirring within the ranks of psychiatry over the last decade. Itself a synthesis of exciting new theoretical perspectives and research advances, the revolution promises to recast much of the field of psychiatry into the framework of the developmental neurosciences. This edited volume, assembled by the preeminent researcher in this field, is a critical vanguard of the research and theory supporting the revolution. She has assembled a remarkable, international cast of scholars, whose expertise ranges from molecular genetics, epidemiology, neurobiology, to child psychiatry, all of whom have contributed excellent chapters. Essential reading for child and adult psychiatrists, as well as developmentalists and neuroscientists with interests in developmental psychopathology.—Peter S. Jensen, M.D, National Institute of Mental Health, Rockville, Maryland

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