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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.
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.


''''==History==
====History====
'''Schizophrenia is a disorder of the brain that is expressed in abnormal mental functions and disturbed behavior'''.Schizophrenia disorders are rare, especially in children. Only 4% of children fifteen and under are affected, and 0.1-1% is affected under the age of ten <ref> Remschmidt, H. E., Schulz, E., Martin, M., Warnke, A. & Trott, G. (1994).'''Childhood schizophrenia ia twice as common in boys and earlier age of onset gender differences disappear in adolescence.''' Childhood Onset Schizophrenia: Historyof the Concept and Recent Studies. Oxford Journals, 20(4). </ref>. People have been and still are reluctant to diagnose schizophrenia early on, primarily due to the stigma attached to it <ref> Wicks-Nelson, R., Israel, A. C. (2009). Pervasive developmental disorders and schizophrenia. Jewell, L. (Eds), Abnormal child and adolescent psychology (327-359)<ref><ref></ref></ref>. Upper Saddle River, NJ: Pearson. </ref>. Until the late nineteenth century, children were often not found to be suffering from psychosis like schizophrenia, but instead said to be suffering from “pubescent” or “developmental” insanity. Through the 1950’s, childhood psychosis began to become more and more common, and psychiatrists began to take a deeper look into the issue <ref> Remschmidt, H. E., Schulz, E., Martin, M., Warnke, A. & Trott, G. (1994). Childhood Onset Schizophrenia: Historyof the Concept and Recent Studies. Oxford Journals, 20(4). </ref>.
Schizophrenia is a disorder of the brain that is expressed in abnormal mental functions and disturbed behavior'''.Schizophrenia disorders are rare, especially in children. Only 4% of children fifteen and under are affected, and 0.1-1% is affected under the age of ten <ref> Remschmidt, H. E., Schulz, E., Martin, M., Warnke, A. & Trott, G. (1994).'''Childhood schizophrenia ia twice as common in boys and earlier age of onset gender differences disappear in adolescence.''' Childhood Onset Schizophrenia: Historyof the Concept and Recent Studies. Oxford Journals, 20(4). </ref>. People have been and still are reluctant to diagnose schizophrenia early on, primarily due to the stigma attached to it <ref> Wicks-Nelson, R., Israel, A. C. (2009). Pervasive developmental disorders and schizophrenia. Jewell, L. (Eds), Abnormal child and adolescent psychology (327-359). Upper Saddle River, NJ: Pearson. </ref>. Until the late nineteenth century, children were often not found to be suffering from psychosis like schizophrenia, but instead said to be suffering from “pubescent” or “developmental” insanity. Through the 1950’s, childhood psychosis began to become more and more common, and psychiatrists began to take a deeper look into the issue <ref> Remschmidt, H. E., Schulz, E., Martin, M., Warnke, A. & Trott, G. (1994). Childhood Onset Schizophrenia: Historyof the Concept and Recent Studies. Oxford Journals, 20(4). </ref>.
By the 1960’s, “childhood schizophrenia” became known as a “heterogeneous mixture” of different diseases, such as autism, symbiotic psychosis, dementia infantilis, etc. Childhood schizophrenia was not directly added to the DSM until 1980 in the DSM-III, which included similar diagnostic criteria as adult schizophrenia <ref> Remschmidt, H. E., Schulz, E., Martin, M., Warnke, A. & Trott, G. (1994). Childhood Onset Schizophrenia: Historyof the Concept and Recent Studies. Oxford Journals, 20(4). </ref>.
By the 1960’s, “childhood schizophrenia” became known as a “heterogeneous mixture” of different diseases, such as autism, symbiotic psychosis, dementia infantilis, etc. Childhood schizophrenia was not directly added to the DSM until 1980 in the DSM-III, which included similar diagnostic criteria as adult schizophrenia <ref> Remschmidt, H. E., Schulz, E., Martin, M., Warnke, A. & Trott, G. (1994). Childhood Onset Schizophrenia: Historyof the Concept and Recent Studies. Oxford Journals, 20(4). </ref>.


Revision as of 03:30, 9 December 2011

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 18. 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. Schizophrenia is especially rare in children under the ages of 7-8 years old [2]. About 50% of young children diagnosed with schizophrenia will experience severe neuropsychiatric symptoms. [3]. Diagnostic criteria are similar to that of adult schizophrenia, however there are differentiating characteristics between the two. Diagnosis is based on observed behavior by caretakers and in some cases depending on age, self reports. It is important to note that diagnosis can only be made by a psychiatrist and licensed psychologist. 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.

History

Schizophrenia is a disorder of the brain that is expressed in abnormal mental functions and disturbed behavior.Schizophrenia disorders are rare, especially in children. Only 4% of children fifteen and under are affected, and 0.1-1% is affected under the age of ten [4]. People have been and still are reluctant to diagnose schizophrenia early on, primarily due to the stigma attached to it [5]. Until the late nineteenth century, children were often not found to be suffering from psychosis like schizophrenia, but instead said to be suffering from “pubescent” or “developmental” insanity. Through the 1950’s, childhood psychosis began to become more and more common, and psychiatrists began to take a deeper look into the issue [6]. By the 1960’s, “childhood schizophrenia” became known as a “heterogeneous mixture” of different diseases, such as autism, symbiotic psychosis, dementia infantilis, etc. Childhood schizophrenia was not directly added to the DSM until 1980 in the DSM-III, which included similar diagnostic criteria as adult schizophrenia [7].

Signs and symptoms

The signs and symptoms of childhood/pediatric schizophrenia are nearly the same as adult-onset schizophrenia. Some of the earliest signs that a young child may develop schizophrenia are developmental lags like language and motor delays. Some children even engage in activities such as arm flapping or rocking and may appear to be anxious, confused, or disruptive on a regular basis. It does not mean that every child who displays these sorts of behaviors in early childhood will one day develop schizophrenia. Children may experience symptoms such as hallucinations, but these are often difficult to differentiate from just normal imagination or child play. It is often difficult for children to describe their hallucinations or delusions, so early-onset schizophrenia is especially difficult to diagnose in the earliest stages. The cognitive abilities of children with schizophrenia may also often be lacking. “Cognitive abilities in the borderline to mentally retarded range have been reported in up to 20% of children with schizophrenia” [8]. Very early-onset schizophrenia (VEOS) characterizes children who experience the onset of the disorder before the age of thirteen years old. “The prodromal phase of VEOS, which precedes the onset of the psychotic symptoms, is characterized by a deterioration in school performance, social withdrawal, disorganized and/or unusual behavior, a decreased ability to perform daily activities, a deterioration in self-care skills, bizarre hygiene and eating behaviors, changes in affect, a lack of impulse control, hostility and aggression, and anergia”. [9].The symptoms of schizophrenia can be classified into separate groups- positive and negative symptoms. Positive symptoms are those symptoms that are “added on” to how a child typically thinks and feels. Negative symptoms are things that are absent in a child’s actions or thoughts compared to a child who does not have the disorder.

Positive Symptoms of Early-Onset Schizophrenia: • Hallucinations • Delusions • Disorganized Speech • Disorganized or catatonic behavior

Negative Symptoms of Early-Onset Schizophrenia: • Flattened affect • Anergia (lack of energy) • Alogia (complete lack of speech) • Avolition (lack of motivation) • Social withdrawal

Most research has concluded that auditory hallucinations are the most common positive symptom in children. Tactile and visual hallucinations seem to be relatively rare. Delusions are reported in more than half of children with schizophrenia but they are usually less complex than those of adults. “In general, active psychotic symptoms, such as auditory hallucinations and delusions, are apparent and prompt hospitalization, while negative symptoms, such as blunted affect and withdrawal, are less likely to attract attention”. [10]. A child’s auditory hallucinations may include voices that are conversing with each other or voices that are speaking directly to the children themselves. Many children with auditory hallucinations believe that if they do not listen to the voices, that the voices will harm the child or someone else. Some children with schizophrenia also report feeling as if an outside force is controlling them or manipulating them in some way.

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. For an accurate diagnosis, the symptoms must be present and persistent for at least 6 months [11] . The label of schizophrenia was often given to children who by today’s standards would fall under a diagnosis of autism or Pervasive Developmental Disorder (PDD). This may be due to the fact that the onset of schizophrenia is gradual, and different symptoms including a history of behavioral, social, language and speech difficulties, abnormalities in motor development, and psychiatric disturbances that appear before the psychotic symptoms However, many symptoms have now been distinguished, which help aid in a proper diagnosis. This assessment allows the psychiatrist to either pinpoint the psychosis, or discover a cause for a different diagnosis. In the early approaches to diagnosing schizophrenia, categories were set to help distinguish a difference between childhood and adult schizophrenia. Current studies however show that the same criteria can be used to diagnose both children and adults with schizophrenia. Diagnosis is usually more challenging when it pertains to children rather than adults [12]

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. Since the thinking and behavior patterns resemble those of other disorders, the psychiatrist may first diagnose the child with a disorder other than schizophrenia. According to the Mayo Clinic, the criteria for diagnosing childhood schizophrenia is similar to that of adults. The criteria is as follows:

  • Presence of at least two of these: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, lack of emotion, social withdrawal, inability to carry out routine daily tasks such as dressing and bathing
  • Failure to achieve the expected level of academic, social or work performance
  • Signs last for at least six months
  • Other mental health disorders have been ruled out

If the symptoms last for a six-month period, further assessments by medical professionals should be done.[13] The American Psychological Association notes that “if delusions are bizarre or if hallucinations consist of a running commentary about the person or two or more conversing voices, then only one of these symptoms is required to make the diagnosis.

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. Three different types of tests are used; physical exam, laboratory and psychological.

Physical Exam

The exams usually cover the basic assessments, including but not limited to; height, weight, blood pressure, and checking all vital signs to make sure the child is healthy. [14]

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, and run additional tests to make sure the thyroid is working properly. [14] Some tests include electroencephalogram EEG screening 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. They will also inquire about the severity of the symptoms, and the effects they have on the child's daily life. Thoughts of suicide or self-harm may also be discussed in these one-on-one sessions. School records may be requested and questionnaires are used to assess anxiety and mood. All will be evaluated on an age appropriate level.[14]

Possible causes

The causes of schizophrenia are largely unknown, but there are many theories about the causes of this rare disorder. There are certain signs that are present in very young toddlers and children that predict that they will later develop schizophrenia. “Premorbid developmental impairments including language, motor and social deficits, are more frequent and more pronounced in earlier- than in later-onset forms of schizophrenia. This pandysmaturation is reported from the first months of life in more than half of the children who will develop childhood-onset schizophrenia, and it suggests a more severe and early disruption of brain development compared with the adolescent- and adult-onset disorder” [15]. Generally, the earlier the onset of the symptoms, the more severe and pervasive the disorder. Premorbid abnormalities and developmental delays are the earliest signs of a child developing schizophrenia. Research has tied schizophrenia to neurological damage. The molecular functioning of individuals with schizophrenia is extremely different from those of normal functioning. Studies have shown that children with this disorder may have progressive ventricular enlargement as well as differences in glucose metabolism. Children and adults with schizophrenia also show differences in autonomic nervous system arousal as well as problems with tracking moving objects. There is some evidence that shows that schizophrenia has a strong genetic component or may be the result of a neurovirus occurring in the second trimester of pregnancy. Another theory on the cause of schizophrenia is that children develop pathological symptoms as the result of anxiety, hypersensitivity, and social detachment. “The child who becomes schizophrenic has been sensitized to the negative characteristics of a parent and incorporates these feelings into his or her own distorted self-image” [16]. A different psychosocial theory says that a person will succumb to schizophrenia when under stress. “The stressors include the neurological dysfunction of schizophrenia and the resulting increase in dopamine activity in the mesolimbic dopamine system, and the psychobiological, environmental, and interpersonal stressors” [17]. Yet another theory about the causes of schizophrenia says that communications within the family lead children to be victims of conflicting messages, which leads to schizophrenic symptoms. This family communication theory has been largely disregarded due to new insight and research on the causes of the disorder.

Treatment

Childhood schizophrenia is a chronic disorder and children with schizophrenia require long-term treatment. Since researchers have yet to detect an exact cause for schizophrenia, medication is aimed to treat and maintain the symptoms associated with the disorder. [18] 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 to “control psychotic symptoms by blocking dopamine transmission at the D2 receptor” [19] The National Institute of Mental Health lists some antipsychotic drugs that may be used include but are not limited to

It is important to note that “although many medications are safe and effective, many of the above mentioned medications have not been studied or approved " [20] for the use of children with schizophrenia. The National Institute of Mental Health also warns that since the medications are FDA approved for adult use, the doctors are able to administer the medication on an “off-label” basis, which means the child is able to receive the medication to help the patient, even though it has not been approved for childhood schizophrenia specifically. More research is needed in the study of the effects of medication on children. The side effects of the medication have serious side-effects and need to be “carefully monitored and managed with changes in dose or type of medication as needed” [21]. The reason it is important to monitor the symptoms, especially during the first two weeks, is because children respond to the medications differently than adults. These side-effects include weight gain and motor dysfunction,

Psychotherapy

Psychotherapy consists techniques for treating mental health and some psychotic 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. Patients who receive the psychotherapy on a regular basis are “more likely to keep taking their medication, and they are less likely to relapse or be hospitalized.” [22] Psychotherapy also helps the patient surmount the negative connotation associated with schizophrenia.

Prospective Outlook

The primary area that children with schizophrenia must adapt to is their social surroundings. It has been found, however, that early-onset schizophrenia carried a more severe prognosis than later-onset schizophrenia. Regardless of treatment, children diagnosed with schizophrenia at an early age suffer diminished social skills, such as educational and vocational abilities [23]. A study also found social disability in the group with onset before age twelve is significantly greater than those 13-18 at age of onset [24]. Psychotherapy is used in order to assist those with schizophrenia understand their disorder and learn to thrive socially with it [25] The stages of development as defined by Erik Erikson would increase the need for psychotherapy as well as family therapy [26]. The parents here can increase their bond with the child and possibly increase the chance of recovery. Children with schizophrenia may never be rid of their symptoms completely, but treatments are in place to assist with coping.

The following statistics were gathered from E. Torrey in “Surviving Schizophrenia”:

After 10 years, of the people diagnosed with schizophrenia: 25% Completely Recover; 25% Much Improved, relatively independent; 25% Improved, but require extensive support networks; 15% Hospitalization, unimproved; 10% Dead (Mostly Suicide)

After 30 years, of the people diagnosed with schizophrenia: 25% Completely Recover; 35% Much Improved, relatively independent; 15% Improved but require extensive support network; 10% Hospitalized, unimproved; 15% Dead (Mostly Suicide) [27].

Prevention

Research efforts are focusing on prevention in identifying early signs from relatives with associated disorders similar with schizophrenia and those with prenatal and birth complications. Prevention has been an ongoing challenge because early signs of the disorder are similar to those of other disorders. Also, some of the schizophrenic related symptoms are often found in children without schizophrenia or any other diagnosable disorder [28]. Some symptoms that may be looked at are early language delays, early motor development delays and school problems [29].

References

  1. ^ [1], Nordqvist, Christian (17 Jun 2010). "What Is Childhood Schizophrenia? What Causes Childhood Schizophrenia?". Medical News Today. Retrieved 13 Jan 2011.
  2. ^ Wicks-Nelson, R., Israel, A. C. (2009). Pervasive developmental disorders and schizophrenia. Jewell, L. (Eds), Abnormal child and adolescent psychology (327-359). Upper Saddle River, NJ: Pearson.,
  3. ^ Lambert, Louise T (Apri-Jun 2001). "Identification and management of Schizophrenia in childhood". Proquest.com. Retrieved 15 October 2011.
  4. ^ Remschmidt, H. E., Schulz, E., Martin, M., Warnke, A. & Trott, G. (1994).Childhood schizophrenia ia twice as common in boys and earlier age of onset gender differences disappear in adolescence. Childhood Onset Schizophrenia: Historyof the Concept and Recent Studies. Oxford Journals, 20(4).
  5. ^ Wicks-Nelson, R., Israel, A. C. (2009). Pervasive developmental disorders and schizophrenia. Jewell, L. (Eds), Abnormal child and adolescent psychology (327-359). Upper Saddle River, NJ: Pearson.
  6. ^ Remschmidt, H. E., Schulz, E., Martin, M., Warnke, A. & Trott, G. (1994). Childhood Onset Schizophrenia: Historyof the Concept and Recent Studies. Oxford Journals, 20(4).
  7. ^ Remschmidt, H. E., Schulz, E., Martin, M., Warnke, A. & Trott, G. (1994). Childhood Onset Schizophrenia: Historyof the Concept and Recent Studies. Oxford Journals, 20(4).
  8. ^ [Masi, G., Mucci, M., & Pari, C. (2006). Children with schizophrenia: Clinical picture and pharmacological treatment. CNS Drugs, 20(10)]
  9. ^ [Masi, G., Mucci, M., & Pari, C. (2006). Children with schizophrenia: Clinical picture and pharmacological treatment. CNS Drugs, 20(10)]
  10. ^ [Spencer, E., & Campbell, M. (1994). Children with schizophrenia: Diagnosis, phenomenology, and pharmacotherapy. Schizophrenia Bulletin]
  11. ^ Mash,J.E., Wolfe,A.D. (2009). Abnormal Child Psychology (4th edition). Belmont, CA: Cengage Learning
  12. ^ Bender, Lauretta. "Childhood Schizophrenia". Psychiatric Quarterly. 27 (1): 663–681.
  13. ^ Diagnostic and statistical manual of mental disorders (4th ed.). American Psychiatric Association. 1994.
  14. ^ a b c http://www.mayoclinic.com/health/childhood-schizophrenia/DS00868/DSECTION=tests-and-diagnosis
  15. ^ [Masi, G., Mucci, M., & Pari, C. (2006). Children with schizophrenia: Clinical picture and pharmacological treatment. CNS Drugs, 20(10)]
  16. ^ [Lambert, Louise T (Apri-Jun 2001). "Identification and management of Schizophrenia in childhood". Proquest.com. Retrieved 15 October 2011]
  17. ^ [ Lambert, Louise T (Apri-Jun 2001). "Identification and management of Schizophrenia in childhood". Proquest.com. Retrieved 15 October 2011]
  18. ^ http://www.nimh.nih.gov/health/publications/schizophrenia/how-is-schizophrenia-treated.shtml
  19. ^ Tiffin, P.A. (2007). Managing psychotic illness in young people: A practical overview. Child And Adolescent Mental Health. 12(4). 173-186. Doi:10.1111/j.1475-3588.2006.00418.x. Retrieved from: EBSCOhost.
  20. ^ http://www.nimh.nih.gov/health/publications/schizophrenia/how-is-schizophrenia-treated.shtml
  21. ^ Tiffin, P.A. (2007). Managing psychotic illness in young people: A practical overview. Child And Adolescent Mental Health. 12(4). 173-186. Doi:10.1111/j.1475-3588.2006.00418.x. Retrieved from: EBSCOhost.
  22. ^ http://www.nimh.nih.gov/health/publications/schizophrenia/how-is-schizophrenia-treated.shtml
  23. ^ Lay, B., Blanz, B., Hartmann, M., & Schmidt, M. H. (2000). The psychosocial outcome of adolescent-onset schizophrenia: A 12-year followup. Schizophrenia Bulletin, 26(4), 801-816. Retrieved from EBSCOhost.
  24. ^ Eggers, C., & Bunk, D. (1997). The long-term course of childhood-onset schizophrenia: A 42-year followup. Schizophrenia Bulletin, 23(1), 105-117. Retrieved from EBSCOhost.
  25. ^ Bellak, L. (1958). Childhood schizophrenia and allied conditions. Benedict, P. K. (Eds), Schizophrenia: A review of the syndrome (555-693). New York, NK: Grune & Stratton.
  26. ^ Bellak, L. (1958). Childhood schizophrenia and allied conditions. Benedict, P. K. (Eds), Schizophrenia: A review of the syndrome (555-693). New York, NK: Grune & Stratton.
  27. ^ Torrey E. F.(2006). Surviving Schizophrenia: A Manual for Families, Patients, and Providers (5th Edition) . Publisher: Quill; 5th edition (April 1, 2006) ISBN: 0060842598
  28. ^ Wicks-Nelson, R., Israel, A. C. (2009). Pervasive developmental disorders and schizophrenia. Jewell, L. (Eds), Abnormal child and adolescent psychology (327-359). Upper Saddle River, NJ: Pearson.
  29. ^ Mayo Foundation for Medical Education and Research (2011). http://www.mayoclinic.com/health/childhood-schizophrenia/DS00868
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