Description

Childhood schizophrenia is a rare but serious mental disorder in which children and adolescents interpret reality abnormally. Schizophrenia involves a range of problems with thinking (cognition), behavior or emotions. This can result in a combination of hallucinations, delusions, and extremely disordered thinking and behavior that affects the child's ability to function.

Childhood schizophrenia is essentially the same as that of schizophrenia in adults, but it starts early in life, in general, in the teenage years — and it has a profound impact on a child's behavior and development. With childhood schizophrenia, early age of onset presents special challenges for diagnosis, treatment, education, and social and emotional development.

Schizophrenia is a chronic disease that requires lifelong treatment. The identification and initiation of treatment for childhood schizophrenia as soon as possible can significantly improve your child's long-term outcome.

Symptoms

Schizophrenia involves a range of problems with thinking, behavior, or emotions. The signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to function. The effect can be disabling.

In the majority of people with schizophrenia, the symptoms usually begin in the mid to late 20 years, although they can start later, in the mid-30's. Schizophrenia is considered as the early start when it starts before the age of 18. The onset of schizophrenia in children under 13 years of age is extremely rare.

The symptoms can vary in type and severity over time, with periods of worsening and remission of the symptoms. Some of the symptoms may always be present. Schizophrenia can be difficult to recognize in the early stages.

The first signs and symptoms

Schizophrenia signs and symptoms in children and adolescents are similar to those in adults, but the condition may be more difficult to recognize in this age group.

The first signs and symptoms can include problems with thinking, behavior, and emotions.

Thought:

  • Problems with thinking and reasoning
  • Strange ideas or speech
  • Confused dreams or reality television

Behavior:

  • Withdrawal from friends and family
  • Sleep problems
  • Lack of motivation — for example, it is shown as a drop in performance at school
  • Not meeting expectations daily living, such as bathing or dressing
  • Strange behavior
  • Violent or aggressive behavior or agitation
  • Recreational drug or the use of nicotine

Emotions:

  • Irritability or depressed mood
  • The lack of emotion or emotions inappropriate to the situation
  • Stranger anxiety and fears
  • Excessive suspicion of others

Later, the signs and symptoms

As children with schizophrenia age, most typical signs and symptoms of the disease start to appear. Signs and symptoms may include:

  • Delusions. These are false beliefs that are not based in reality. For example, you think that you're being harmed or harassed; certain gestures or comments are directed at you, that you have exceptional ability or fame; another person is in love with you; or that a great catastrophe is about to occur. Delusions occur in most people with schizophrenia.
  • Hallucinations. These usually involve seeing or hearing things that do not exist. However, for the person with schizophrenia, hallucinations have the full force and impact of a normal experience. The hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
  • Disorganized thinking. Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.
  • Extremely disorganized or abnormal motor behavior. This can manifest itself in several forms, from the child of the stupidity of the agitation unpredictable. Behavior is not focused on a goal, which makes it difficult to do tasks. The behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
  • The negative symptoms. This refers to the reduction or absence of the ability to function normally. For example, the person may neglect personal hygiene or lack of emotion — does not contact with the eyes, not to change the facial expressions, speaking in a monotonous tone, or not, of hand or of head movements that usually occur when you are speaking. Also, the person may avoid people and activity or the lack of ability to experience pleasure.

In comparison with the symptoms of schizophrenia in adults, children and teenagers can be:

  • Less prone to having delusions
  • More likely to have visual hallucinations

The symptoms can be difficult to interpret

When childhood schizophrenia begins early in life, symptoms may gradually build up. The first signs and symptoms can be so vague that you can not recognize what is wrong. Some of the earliest signs may be confused with a normal development during the first years of adolescence, or they could be symptoms of other mental or physical conditions.

As the time passes, the symptoms may be more severe and more noticeable. Eventually, the child may develop the symptoms of psychosis, including hallucinations, delusions, and the difficulty organizing thoughts. As the thoughts become more disorganized, often there is a "break from reality" (psychosis), often require hospitalization and treatment with medication.

When to see a doctor

It can be difficult to know how to handle vague behavior changes in your child. You may be afraid to rush to conclusions that the label of your child with a mental illness. Your child's teacher or other school personnel may be alert to changes in your child's behavior.

Seek medical attention as soon as possible if you have any concerns about your child's behavior or development.

Suicidal thoughts and behavior

Suicidal thoughts and behavior are common among people with schizophrenia. If you have a child or teen that may be at risk of attempting suicide or has made a suicide attempt, make sure someone stays with him or her. Call 911 or the local emergency number immediately. Or if you think that you can do so safely, take your child to the nearest emergency room.

Causes

There is No known cause of childhood schizophrenia, but it is the thought that is developed in the same way that adults with schizophrenia do not. The researchers believe that a combination of genetics, brain chemistry, and the environment contributes to the development of the disease. It is not clear why the schizophrenia begins so early in life for some and not for others.

Problems with certain naturally brain chemicals, including neurotransmitters dopamine and glutamate, may contribute to schizophrenia. Neuroimaging studies show differences in the structure of the brain and the central nervous system of people with schizophrenia. While researchers are not sure about the significance of these changes, which indicate that schizophrenia is a brain disease.

Risk factors

Although the exact cause of schizophrenia is not known, there are certain factors which appear to increase the risk of developing or triggering schizophrenia, including:

  • Having a family history of schizophrenia
  • The increased activation of the immune system, such as inflammation
  • The advanced age of the father
  • Some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may affect the development of the brain
  • Taking mind-altering (psychoactive) drugs in adolescence

Complications

Left untreated, childhood schizophrenia can result in serious emotional, behavioral, and health problems. The complications associated with schizophrenia can present in childhood or later, such as:

  • Suicide, suicide attempts and thoughts of suicide
  • Self-injury
  • Anxiety disorders, panic disorders, and obsessive-compulsive disorder (OCD)
  • Depression
  • The abuse of alcohol or other drugs, including nicotine
  • Family conflicts
  • Inability to live independently, attend school, or work
  • Social isolation
  • Health and medical problems
  • To be victims of
  • Legal and financial problems, and lack of housing
  • Aggressive behavior, although uncommon,

Prevention

The early identification and treatment may help get symptoms of childhood schizophrenia under control before serious complications develop. Early treatment is also crucial in helping to limit psychotic episodes, which can be very scary for a child and his or her parents. Course of treatment can help your child's long-term vision.

Diagnosis

The diagnosis of childhood schizophrenia involves ruling out other mental health disorders and determining that symptoms are not due to the consumption of alcohol or use of drugs, medication or a medical condition. The diagnostic process may involve:

  • Physical exam. This can be done to help rule out other problems that could be causing symptoms and to check for any related complications.
  • Tests and exams. These may include tests that help rule out conditions with similar symptoms, and screening for alcohol and drugs. The doctor may also order imaging studies, such as mri or a ct scan.
  • Psychiatric evaluation. This includes the observation of the appearance and behavior, wondering about the thoughts, feelings and patterns of behavior, including thoughts of harming yourself or others, the assessment of the ability to think and function at an appropriate age, and to assess mood, anxiety, and possible psychotic symptoms. This also includes a discussion of the family and personal history.
  • Criteria for the diagnosis of schizophrenia. Your doctor or mental health professional may use the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American psychiatric Association.

Challenging process

The path for the diagnosis of childhood schizophrenia can sometimes be long and difficult. In part, this is due to other conditions, such as depression or bipolar disorder, can have similar symptoms.

A child psychiatrist may want to monitor your child's behavior, perceptions and patterns of thought, for several months or more. As the thought and behavior patterns, and the signs and symptoms become more clear over time, a diagnosis of schizophrenia can be made.

In some cases, a psychiatrist may recommend at the beginning of the medications before we make an official diagnosis. This is especially important for the symptoms of aggression or self-injury. Some medications can help limit these types of behavior.

Treatment

Schizophrenia in children requires lifelong treatment, even during periods in which the symptoms seem to disappear. The treatment is a particular challenge for children with schizophrenia.

Treatment team

Childhood schizophrenia treatment is usually guided by a child psychiatrist with experience in the treatment of schizophrenia. The team approach may be available in clinics with expertise in the treatment of schizophrenia. The team may include, for example, your:

  • Psychiatrist, psychologist or other therapist
  • Psychiatric nursing
  • Social Worker
  • The members of the family
  • Pharmacist
  • Case manager to coordinate care

Main treatment options

The main treatments for childhood schizophrenia are:

  • Drugs
  • Psychotherapy
  • Life skills training
  • Hospitalization

Drugs

Most of the antipsychotic drugs used in children are the same as those used for adults with schizophrenia. Antipsychotic drugs are often effective in the management of symptoms such as hallucinations and delusions.

In general, the goal of treatment with antipsychotics is to effectively manage the symptoms at the lowest dose possible. Over time, your child's doctor, you can try different combinations drugs or different doses. Depending on the symptoms, other medications can also help, such as antidepressants or anti-anxiety medications. It may take several weeks after starting a medication to notice an improvement in symptoms.

The second-generation antipsychotics

More recent, second-generation medications are generally preferred because they have fewer side effects than first-generation antipsychotics do. However, they can cause weight gain, high blood sugar, high cholesterol, or heart disease.

Examples of second-generation antipsychotics approved by the Food and Drug Administration (FDA) for the treatment of schizophrenia in adolescents aged 13 years of age and older include:

  • Aripiprazole (Abilify)
  • Lurasidone (Latuda)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)

Paliperidone (invega) is FDA-approved for children 12 years of age and older.

The first generation of antipsychotics

The first generation of medicines are usually as effective as second-generation antipsychotics in the control of delusions and hallucinations. In addition to having some side effects similar to those of second-generation antipsychotics, first-generation antipsychotics may also have frequent and potentially serious neurological side effects. These include the possibility of developing a movement disorder called tardive dyskinesia, which may or may not be reversible.

Due to the increased risk of serious side effects with the first generation of antipsychotics, which are often not recommended for use in children until other options have been tried without success.

Examples of first-generation antipsychotic approved by the FDA for the treatment of schizophrenia in children and adolescents include:

  • Perphenazine for children 12 years and older
  • Thiothixene for children 12 years and older

Side effects of medications and the risks

All antipsychotic medications have side effects and potential health risks, some life threatening. Side effects in children and adolescents may not be the same as that of adults, and can sometimes be more serious. Children, especially very young children, it may not have the capacity to understand or communicate about the issues related to medicines.

Talk with your child's doctor about the possible side effects and how to manage them. Be aware of your child's problems, and report side effects to your doctor as soon as possible. The doctor may be able to adjust the dose or change the medication, and to limit the side effects.

Also, the antipsychotic drugs can have dangerous interactions with other substances. Tell your doctor about all medications and otc products does your child take including vitamins, minerals, and herbal supplements.

Psychotherapy

In addition to medication, psychotherapy, sometimes called talk therapy, can help control the symptoms and help you and your child cope with the disorder. Psychotherapy may include:

  • Individual therapy. Psychotherapy, such as cognitive-behavioral therapy, with an expert mental health professional can help to reduce symptoms and help your child to learn ways to cope with the stress of the daily life and challenges of schizophrenia. Learn about schizophrenia can help your child to understand the disease, to deal with the symptoms and adhere to a treatment plan.
  • The therapy of the family. Your child and your family can benefit from therapy that provides support and education to families. Involved, care of family members can be very helpful for children with schizophrenia. Family therapy can also help your family to improve communication, resolve conflicts, and deal with the stress associated with the condition of your child.

Life skills training

Treatment plans that include building life skills you can help your child as a function of age appropriate levels when possible. Skills training may include:

  • Social skills and academic training. Training in social and academic skills is an important part of treatment for childhood schizophrenia. Children with schizophrenia often have conflicting relationships and school problems. They may have difficulties carrying out typical daily tasks such as bathing or dressing.
  • The vocational rehabilitation and supported employment. This focuses on helping people with schizophrenia to prepare for, find and keep jobs.

Hospitalization

During periods of crisis or in times of severe symptoms, hospitalization may be necessary. This can help to ensure the safety of your child and make sure that he or she is receiving the proper nutrition, sleep, and hygiene. Sometimes, the hospital is the safest and the best way to get the symptoms under control quickly.

Partial hospitalization and residential care options may be available, but serious, the symptoms tend to be stabilized in the hospital before passing to these levels of care.

Lifestyle and home remedies

Although childhood schizophrenia requires professional treatment, it is essential to be an active participant in your child's care. Here are the ways to get the most out of the treatment plan.

  • Follow the instructions of the drug. Try to make sure that your child take the medicine as directed, even if he or she feels well and has no current symptoms. If the medication has been stopped or is taken infrequently, the symptoms are likely to return and your doctor will have a hard time to know what is the best and safest dose.
  • Check before you take any other medicines. In touch with the doctor who treats your child for schizophrenia before your child take medications prescribed by another doctor before you take any over-the-counter medications, vitamins, minerals, herbs or other supplements. These may interact with medications for schizophrenia.
  • Pay attention to the warning signs. You and your child may have identified the things that can trigger the symptoms, the cause of a relapse or prevent your child from carrying out daily activities. Make a plan so you know what to do if symptoms return. Contact your doctor or therapist if you notice any change in your symptoms, to prevent the situation from getting worse.
  • Make physical activity and healthy eating is a priority. Some medications for schizophrenia is associated with an increased risk of weight gain and high cholesterol in children. Work with your child's doctor to make a nutrition and physical activity plan for your child that you are going to help control the weight and to the benefit of the health of the heart.
  • Avoid alcohol, recreational drugs and nicotine. Alcohol, recreational drugs and nicotine, can worsen the symptoms of schizophrenia or interfere with antipsychotic medications. Talk with your child about avoiding drugs and alcohol, and not smoking. If necessary, receive the appropriate treatment for a substance use problem.

Coping and support

Coping with childhood schizophrenia can be a challenge. Medications can have unwanted side effects, and you, your child and your entire family may feel angry or resentful for having to manage a condition that requires life-long treatment. To help deal with childhood schizophrenia:

  • Learn about the condition. Education about schizophrenia can give you and your child and motivate you to stick with the treatment plan. Education can help friends and family understand the condition and to be more compassionate with your child.
  • Join a support group. Support groups for people with schizophrenia can help you to reach out to other families who face similar challenges. You may want to search for separate groups for you and for your son, so that each of you have a safe outlet.
  • Get professional help. If you, as a parent or guardian feel overwhelmed and distressed by the illness of her child, consider seeking the help of a mental health professional.
  • Stay focused on the objectives. Dealing with childhood schizophrenia is an ongoing process. Stay motivated as a family by maintaining the goals of treatment in mind.
  • Find healthy communication. Explore healthy ways of your whole family can channel energy or frustration, such as hobbies, exercise and recreational activities.
  • Make healthy lifestyle choices. Keep a regular schedule that includes enough sleep, healthy eating and regular physical activity is important for mental health.
  • Take the time as individuals. Although the management of childhood schizophrenia is a matter of family, children, and parents need their own time to meet and relax. Create opportunities for healthy alone time.
  • Start planning for the future. Ask about the social services assistance. The majority of individuals with schizophrenia require some form of daily life support. Many communities have programs to help persons with schizophrenia to employment, affordable housing, transportation, self-help groups, other activities and situations of crisis. A case manager or someone on the treatment team can help you find resources.

Preparing for your appointment

It is likely that you start by having your child see your pediatrician or family doctor. In some cases, you may be referred immediately to a specialist, such as a pediatrician, psychiatrist, or other mental health professional who is an expert in schizophrenia.

In the rare cases in which security is a problem, your child may require emergency evaluation in the emergency room and possibly of admission for psychiatric care in a hospital.

What you can do

Before the appointment, make a list of:

  • The symptoms that I noticed, even when these symptoms began and how they have changed over time — give specific examples
  • Key personal information, including any major stresses or recent life changes that may affect your child
  • Other medical conditions, including mental health problems, your child has
  • All the prescription and over-the-counter medications, vitamins, herbs, or other supplements that your child takes, including the dose
  • Questions to ask the doctor

Basic questions to ask the doctor may include:

  • What is likely causing my child's symptoms or condition?
  • What are other possible causes?
  • What kind of evidence does my child need?
  • Is my child's condition likely temporary or long-term?
  • How are you going to a diagnosis of childhood schizophrenia affect the life of my son?
  • What is the best treatment for my child?
  • What specialists does my child need to see?
  • Who else will be involved in the care of my child?
  • Are there brochures or other printed material I can have?
  • What sites do you recommend?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your child's doctor is likely to ask you and your child a series of questions. Anticipating some of these questions will help you to make the discussion productive. Your doctor may ask:

  • When did symptoms begin?
  • The symptoms have been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • How to make the symptoms affect your child's daily life?
  • Has relatives been diagnosed with schizophrenia or another mental illness?
  • Has your child experienced any physical or emotional trauma?
  • Do the symptoms seem to be related to major changes or factors of stress within the family or social environment?
  • Have any other medical problems, symptoms, such as headaches, nausea, tremors, or fevers, occurred around the same time as the onset of symptoms?

The doctor will ask additional questions based on the answers, the symptoms and needs.

Symptoms and treatment of Childhood schizophrenia