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Schizophrenia, Adolescent / Childhood Schizophrenia

Definition :
Schizophrenia is a chronic, debilitating mental illness that causes people to experience the world differently than most other people do. Consequently, the way they communicate and behave often appears to be disorganized, illogical, detached, imaginary or paranoid.

Childhood schizophrenia is rare, affecting an estimated one in 40,000 children under the age of 13. During early teen years, the rate of schizophrenia onset in the general population begins to increase, and the peak rates of onset lie between the ages of 15 and 30. Males tend to experience the first signs and symptoms of schizophrenia at the younger end of this range, while onset in females is usually at the older end.

While childhood schizophrenia is essentially the same brain disorder as schizophrenia in adults, the early age of onset presents special considerations for diagnosis, treatment, educational needs, emotional and social development, family relationships, and other factors.

Although there's no cure for childhood schizophrenia, medications and well-coordinated mental health care services can help families manage the disease, learn strategies to cope with the effects of childhood schizophrenia, and address other child and adolescent developmental needs.

Most researchers believe that schizophrenia results from problems with early brain development. Studies have focused on the way brain cells communicate with each other through nerve pathways. Too many or too few connections in the important pathways of emotional regulation may lead to psychotic symptoms. More specifically, certain areas of the brain that are rich in the chemical dopamine seem to be affected most often in schizophrenia.

The contributing factors associated with the development of these brain-pathway problems are controversial and are being carefully investigated. Some of the areas of current research include risk-associated genes, exposure to certain viruses or malnutrition in the womb, and stressful childhood environments in genetically susceptible children.

When to seek medical advice :
If your child displays psychotic behaviors, don't hesitate to seek medical advice. If you're concerned about changes in behavior, difficulty at school, or problems in social or interpersonal interactions, consult your pediatrician, a pediatric psychiatrist or other mental health professional specializing in child development. Your child's teacher or other school personnel also may bring to your attention changes in your child's behavior or function that merit professional consultation.

A child or adolescent with schizophrenia may experience severe deterioration in the ability to function in social, personal and regular daily activities. Signs and symptoms of the disease, which are known collectively as psychosis, include :

  • Hearing voices or experiencing other sensory events that aren't real (hallucinations)
  • Holding untrue beliefs about reality (delusions)
  • Disorganized thinking
  • Grossly disorganized, irrational behavior
  • Physical immobility
  • Excessive mobility with no purpose
  • Absent or inappropriate emotional expression
  • Little verbal communication with other people
  • Inability to initiate plans

When childhood schizophrenia begins very early, the disease often manifests itself gradually and builds up to the first psychotic episode. Early signs of the disease may include social withdrawal, disruptive behaviors, academic problems, speech or language problems, or other developmental delays. These early signs aren't specific to childhood schizophrenia and may indicate a variety of other conditions.

In adolescents, schizophrenia may also begin gradually, but the sudden appearance of psychotic symptoms and deterioration in hygiene and functioning is more common in this age group than in younger children.

Your doctor will most likely refer you to a psychiatrist for evaluation. A complete diagnostic workup will include :

  • A complete medical, social and family history
  • Interviews with child and parents or guardians to assess possible psychotic symptoms, changes in behavior and the possibility of other psychiatric disorders
  • Tests to assess cognitive skills and functional abilities in daily life
  • A review of school records or other input from school personnel
  • Blood and brain-imaging tests to rule out other medical conditions

This process takes time. Your psychiatrist will make a diagnosis of schizophrenia only if psychotic behaviors and other diagnostic criteria continue for at least six months, and no other causes for the signs and symptoms have been found.

During that time he or she will want to know not only what kinds of behaviors, perceptions and thinking are manifested but also what patterns exist. For example, your psychiatrist will want to know whether problems occur only at home or at school or whether they're manifested in all environments. He or she will inquire about many educational, personal, familial and social factors that may contribute to your child's condition.

Before six months have passed or if the signs and symptoms don't last for a full six months, your psychiatrist may make a temporary diagnosis of schizophreniform disorder or psychotic disorder "not otherwise specified." As the pattern and impact of the illness become clearer, the diagnosis may change.

Diagnostic challenges
Childhood schizophrenia is difficult to diagnose for a number of reasons. Because it's rare, doctors not specializing in pediatric psychiatry may have limited experience with diagnosing schizophrenia in younger people.

Behaviors or thoughts that may appear related to delusions or hallucinations may simply be the product of a lively imagination, especially in younger children. However, these behaviors or thoughts would usually not cause impairment.

Some signs and symptoms of schizophrenia overlap with those of other mental health or developmental disorders. In fact, your psychiatrist will want to rule out these disorders before making a diagnosis of schizophrenia :

  • Bipolar disorder
  • Schizoaffective disorder, a condition with some manifestations of both schizophrenia and a mood disorder
  • Severe anxiety disorders
  • Severe major depression with psychotic features
  • Post-traumatic stress disorder
  • Substance abuse disorders (particularly cocaine and methamphetamine)
  • Delusional disorders
  • Medical disorders that affect the brain
  • Personality disorders
  • Autism spectrum disorders

Treatment models for childhood schizophrenia are based primarily on adult treatments and interventions, which have been studied more thoroughly.

Medications known as atypical antipsychotics are the mainstay of treatment. These medications help to suppress psychotic behaviors through regulation of dopamine-associated nerve pathways. These drugs may prevent the recurrence or lessen the intensity of psychotic episodes.

A child's first experience with a psychotic episode can be very frightening and disruptive. While there may be much to learn about your child's condition over the course of several months, dealing with the immediate crisis of a psychotic episode is essential. Because of this, your physician may begin treatment with these medications even before making a final diagnosis.

Your physician will monitor your child closely for both the treatment effect of medications and potential adverse effects. Side effects in children and adolescents may not be the same as those in adults, and children may not have the capacity to understand or communicate about adverse problems.

It's important to report any observable medication side effects to your doctor immediately. By spotting medication problems early, your physician can adjust dosing or choice of medication. Such careful monitoring may improve the overall course of treatment and may help you and your child adhere to treatment guidelines.

Other interventions
Other interventions for childhood schizophrenia designed to complement drug treatment may include :

  • Ongoing, age-appropriate education about the disease and treatment options for both the child and family members, including siblings
  • Social skills and basic life skills training at home, school and in the community
  • Psychotherapy for child and parents or guardians that focuses on coping strategies, problem-solving skills, and awareness of symptoms and the circumstances that may prompt or exacerbate them
  • Special educational programs that address learning and developmental needs
  • Day programs or at-home services for children who can't attend school for an entire day
  • Hospitalization when psychotic behaviors aren't well-managed by drug treatment or when behaviors, particularly paranoid delusions or hallucinations, present a danger to the child or others
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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