Pediatric schizophrenia

Pediatric schizophrenia (also known as childhood onset schizophrenia)^[1] is a type of mental disorder that is characterized by degeneration of thinking, motor, and emotional processes in children and young adults under the age of 17. Schizophrenia is especially rare in children under the age of twelve years old. This disorder usually develops in the late adolescent years but it can also affect young children. About 50% of young children diagnosed with schizophrenia will experience severe neuropsychiatric symptoms. ^[2]. Patients are unable to distinguish between what is real and what is not. The disease is illustrated by symptoms such as auditory and visual hallucinations, strange thoughts/feelings, and abnormal behavior therefore profoundly impacting the child’s ability to function and sustain normal interpersonal relationships. Diagnostic criteria are similar to that of adult schizophrenia other than the age of onset. Diagnosis is based on observed behavior of caretakers and in some cases depending on age, self reports.

Schizophrenia has no definite cause, however, certain risk factors seem to correlate. Suggestions of causes combine multiple factors, not just one, that could contribute to the onset of the disease. Genetics play a large part in patients with schizophrenia, with higher rates found in children of schizophrenics. There is no known cure but childhood schizophrenia is controllable with the help of the proper fusion of behavioral therapies and medications.

Signs and symptoms

Signs are physical states that others can see and observe while symptoms are something that a third party is unaware of but the patient describes. When children develop Schizophrenia very early in life, their signs seem to be a possible developmental phase and start off small and insignificant. As the disorder progresses, children will begin showing signs of psychosis and experiencing symptoms such as, but not limited to, delusions, hallucinations and disorganized thoughts. As the symptoms become more severe, a break from reality occurs and this is when medical attention is needed.^[3]

Negative symptoms

The term “negative symptom” is used to describe a normal function that most people have which are not present in a schizophrenic patient. These symptoms include

• Lack of motivation
• Lack of emotion
• Social withdrawal
• Inability to take care of oneself
• Poor school performance.^[4]

Positive symptoms

As the counterpart to negative symptoms, positive symptoms are described as being present in a schizophrenic patient while not present in non-patients. These include:

• Seeing or hearing things, especially voices, that do not exist (Hallucinations)
• Having beliefs that are not based in reality (Delusions)
• Having inappropriate emotions to certain situations
• Being easily agitated
• Illogical thinking and incoherent speech
• Strange eating habits

Positive symptoms are usually easier to treat than negative symptoms and are easier to sustain a better quality of life.^[3]

Diagnosis

Diagnosis is based on reports by parents/caretakers, teachers, school officials and others close to the child. If any abnormalities in behavior are present, psychiatrists or other professionals in the mental health fields do a further assessment. Diagnosis is usually more challenging when it pertains to children rather than adults ^[5]

Criteria

The Diagnostic and Statistical Manual of Mental Disorders, version DSM-IV is the standardized manual used in the United States to diagnose mental disorders. The criteria used to diagnose the disorder is as follows: Two or more of the following symptoms present for a significant portion of time during a one-month period.

• Delusions
• Hallucinations
• Disorganized speech
• Disorganized behavior
• Social dysfunction (interpersonal or academic achievement)

If the symptoms last for a six-month period, further assessments by medical professionals should be done.^[6]

Diagnostic examinations

If a professional believes that a child has schizophrenia, a series of tests are usually performed in order to rule out other causes of behavior and pinpoint a diagnosis. Two different types of tests are used; laboratory and psychological.

Laboratory

Physical exams alone cannot completely diagnose schizophrenia, but they do help rule out other diseases that can be causing the behavior. Doctors may run tests on the brain to see if any abnormalities exist. Some tests include EEG exams and brain imaging scans. Blood tests are used to rule out alcohol or drug effects being a factor.

Psychological

A psychologist or psychiatrist will talk to a child about their thoughts, feelings and behavior patterns and ask about how severe the symptoms are and the effect they have on daily life. Thoughts of suicide or self-harm may also be discussed in these one-on-one exams. School records may be requested and questioners are used to assess anxiety and mood. All will be evaluated on an age appropriate level.

Possible causes

Evidence suggests that there is a large hereditary component with schizophrenia. Research proposes that schizophrenia is caused by genetic vulnerability coupled with environmental stressors.

Environmental causes

Environmental causes will be described as any factor that is not genetic or hereditary (any macro-factor). Some possible environmental risk factors comprise of:

• Disturbed family/ interpersonal problems
• Being from a low-class household/poverty
• Inadequate social resources

These alone do not cause schizophrenia. There needs to be some kind of genetic predisposition coupled with these factors.

Genetic causes

The link between genetics and schizophrenia is seemingly strong. Many believe that changes in neo-natal development cause the disorder while others believe it is hereditary, but neither have concrete support. If neither parent has the disorder there is a 1% chance that a child will develop it but the chances increase to 10% if one parent has schizophrenia. Possible genetic causes may be:

• Family history of the disorder
• Exposure to viruses in the womb
• Prenatal malnutrition
• Certain drugs
• Stressful situation early in life

Treatment

Childhood schizophrenia is chronic and children with schizophrenia require permanent treatment.^[4] Treatment is the same for all forms of schizophrenia. However, because childhood is such a molding period, treatment can be a challenge.

Medications

Most medications used for childhood schizophrenia are the same as the ones used for adult schizophrenia, with antipsychotics being the most important step in treatment. Some drugs that may be used include but are not limited to

• Risperidone (Risperdal)
• Aripiprazole (Abilify)

Psychotherapy

Psychotherapy consists techniques for treating mental health and some psychiatric disorders. It helps patients understand what helps them feel positive or anxious, as well as accepting their strengths and weaknesses. On an individual basis, the patient learns about their disorder and learns to cope with persistent symptoms. Psychotherapy also helps the patient surmount the negative connotation associated with schizophrenia.

References

1. ^ Nordqvist, Christian (17 Jun 2010). "What Is Childhood Schizophrenia? What Causes Childhood Schizophrenia?". Medical News Today. http://www.medicalnewstoday.com/articles/192104.php. Retrieved 13 Jan 2011. 
2. ^ Lambert, Louise T (Apri-Jun 2001). "Identification and management of Schizophrenia in childhood". Proquest.com. Retrieved 15 October 2011.
3. ^ ^{a b} Segal, Robert; Smith, Melinda. "Understanding Schizophrenia: A GUIDE TO THE SIGNS, SYMPTOMS, AND CAUSES". HelpGuide.org. http://www.helpguide.org/mental/schizophrenia_symptom.htm. Retrieved 13 Jan 2011. 
4. ^ ^{a b} "Schizophrenia in children". American Academy of Child & Adolescent Psychiatry. Nov 2004. http://aacap.org/page.ww?name=Schizophrenia+in+Children&section=Facts+for+Families. Retrieved 13 Jan 2011. 
5. ^ Bender, Lauretta. "Childhood Schizophrenia". Psychiatric Quarterly 27 (1): 663–681. 
6. ^ Diagnostic and statistical manual of mental disorders (4th ed.). American Psychiatric Association. 1994.