SCHIZOPHRENIA
What is Schizophrenia?
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Schizophrenia is a medical illness that
causes strange thinking, abnormal
feelings, and unusual behavior.
It is uncommon in children and hard to
recognize in its early stages.
Adult behavior often differs from that of
teens and children.
Symptoms of Diagnosis
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In children, Schizophrenia is preceded by
developmental disturbances. (speech
problems, lacking needed motor skills…)
Diagnostic criteria is the same for both
children and adults, only symptoms must
appear prior to 12 years of age.
May see or hear things that do not exist
May be paranoid or have bizarre beliefs
Other Symptoms
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Problems paying attention
Impaired memory
Inappropriate expressions (laughing
something is not funny such as some one
being hurt)
Poor social skills
Depressed mood
Diagnosis Problems
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Often misdiagnosed in children
Mistaken for autism, personality disorders,
bipolar disorder and dissociative disorders
Abused children may hear voice of abuser
or see visions of abuser
Bottom Line: Schizophrenia is hard to
diagnose in children!
Early Warning Signs
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Trouble discerning dreams from reality
Seeing things and hearing voices that are
not real
Extreme moodiness
Concept that people are “out to get them”
Confusing television with reality
Severe problems making friends
DSM IV
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Characteristic Symptoms: Two or more of the following present for a
significant portion of time during a 1 month period (less if successfully
treated):
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Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Negative symptoms (affective flattening)
Social/Occupational dysfunction
Duration: Continuous signs of disturbance persist for at least 6 months. This
6 month period must include 1 month of symptoms.
Type:
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Paranoid type
Disorganized type
Catatonic type
Undifferentiated type
Residual type
Epidemiology
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Less than 1% for children under 19 years of age
Never diagnosed under the age of 5 and rarely before
age 15
Boys are at 2:1 advantage of an early onset compared to
girls
Boys first psychotic break between 15-24
Girls first psychotic break between 20-29
Levels out for older adolescents and adults
Children: No SES ties or racial/ethnic ties
Adults: Over diagnosed in African Americans
World wide Schizophrenia is very evenly spread
Comorbidity
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Substance abuse disorder
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Common substances are alcohol, stimulants such as cannabis,
cocaine and amphetamines
33.7% of people with Schizophrenia disorder or
schizophreniform met criteria for alcohol abuse
47% met criteria for any substance abuse
43% in 125 male patients consumed cannabis
20% for cocaine, 3% heroin, and nicotine between 70-90%
80% out of 62 adolescents with schizophrenia had comorbidity
with substance use in New Zealand
69% of children with Schizophrenia met criteria for another
psychiatric disorder
Comorbidity
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Obsessive-Compulsive disorder
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Depression
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7.8% with schizophrenia had OCD
26% out of 50 patients met criteria for OCD
25% prevalence rate with Schizophrenia
Suicide
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10% of patients commit suicide
Suicide attempts are 5 times higher than suicide rate
Comorbidity
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Other comorbid disorders
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Social phobia
Generalized anxiety
Avoidant personality disorder
Eating disorder
Conduct disorder
Etiology
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Strong evidence of genetic component to
development of Schizophrenia.
The stronger the genetic compatibility
between individuals, the higher the
concordance rates. Cont…
Concordance Rates
Non twin siblings:
9%
 One biological parent
13%
 Dizygotic twins
17%
 Both parents
46%
 Monozygotic twins
48%
(Also children of Schizophrenic mothers are
at greater risk regardless of who raises
them)
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Etiology cont…
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Evidence of prenatal and biological factors that
lead to Schizophrenia.
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Disruptions in brain development during prenatal
period
Complications during pregnancy
Studies suggest that brain abnormalities are evident
in children/adolescents with Schizophrenia
Decrease in grey matter in frontal and temporal
regions
Developmental Pathways
Delayed developmental milestones such
as walking or talking
 Poor academic work
 High levels of impulsivity
 High levels of social withdrawl
When Schizophrenia appears in childhood it
is often a life long disorder.
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Developmental Pathways
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First psychotic break in childhood often is
followed by multiple other breaks
throughout life.
After the disorder develops, more
noticeable complications arise:
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Social isolation
Economic impairment
Academic deficits
Developmental Pathways
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Long term prognosis is generally related to age
of onset. (Earlier onset=poorer prognosis)
Childhood onset usually continues throughout
adulthood.
Full recovery is rare.
Best hope is remission from active symptoms
through intensive therapeutic interventions and
psychopharmacology.
Treatment
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Medication: “atypical” antipsychotics
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Olanzapine
Clozapine
Used to reduce symptoms such hallucinations
and delusions
New medicines help reduce chance of tardive
dyskinesia
Treatment
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Side effects of medication:
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Weight gain
Blood disorder (agranulocytosis)
Nausea
Urinary retention
Impotence
Hyper salivation
Dyskinesia
Depression
Treatment
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Typically a combination of medication
(clozapine) and individual therapy, family
therapy along with specialized programs is
necessary.
Medications can have many side effects.
www.nimh.com
Case Study
Reported is a case of an early onset of Schizophrenia with a translocation between chromosomes
1 and 7. An 11 year old male was admitted to NIMH with symptoms including: disorganized speech, rambling, a
2 year history of agitation, beliefs that ghosts were talking to him and could control his mind and that “rough
hands” were pursuing him at night. His parents’ first concern came during day care at age 4 when it was
reported to them their son was socially isolated and continually holding his genitals. At age 5 he began special
programs for education. At age 9 an evaluation at a university hospital shows low intelligence and a language
disorder. The patient has hypotonia with gross and fine motor delays. He continued to have abnormal thoughts
and an inability to focus. His symptoms from ages 9-11 showed symptoms of paranoid delusions, grandiosity,
mind control, auditory hallucinations, visual hallucinations, and tactile hallucinations. As for the patient’s
developmental history, the mother had pregnancy complications with insulin-dependant diabetes preceded by two
trimesters of hypoglycemia that resulted in loss of consciousness and 6 hospitalizations. She also had a greater
that 50 pound weight gain. The patient walked by 14 months but did not have normal babbling and did not
speak until age 3. He had a good temperament that did not include separation anxiety and no temper tantrums.
At age 11 the NIH completed a physical that concluded the boy’s body was at a disproportion, having abnormally
long limbs compared to his torso, a triangular face and small mouth. The patient displayed inappropriate
laughing and an inability to make eye contact. The patient met all criteria for the DSM-III-R for schizophrenia
and was admitted to the NIMH at age 11 ½ years. Patient responded well to clozapine.
To further iterate, the patient had 3 other relatives whose DNA contained the 1 and 7 chromosome
translocation, none of which were diagnosed with schizophrenia. They did have symptoms of drug/alcohol abuse
and language delay. Another study showed an autistic boy with 7 and 21 translocation of chromosomes that also
had a 1 chromosome in the same location of the patient discussed. The patient did show some early signs of
autism but not enough to be diagnosed. The relationship between autism and early childhood schizophrenia is
still not clear, but studies have shown that 40% prepubertal schizophrenics did have autistic symptoms. At the
time of this study it is hard to state the role of genetics in this patient’s schizophrenia. Certainly more research
needs to be conducted, but this is very good start.