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Schizophrenia

Created on August 5, 2017. Last updated on October 12th, 2018 at 01:50 pm

What is Schizophrenia

Schizophrenia is the most common psychotic disorder and is characterized by unusual thoughts, unstable and intense emotions, and strange behavior. People with schizophrenia may be unable to consistently distinguish what is real from what is imaginary and may perceive images, sounds or other sensory experiences in the absence of a stimulus. People with schizophrenia may also struggle to care for themselves and may withdraw from activities or people they normally enjoy, and/or express fear and anxiety that interferes with their functioning.

Childhood-onset schizophrenia is rare and represents a severe form of the disorder, with more pronounced early neurodevelopment abnormalities and often a chronic, treatment-refractory course. It also poses unique challenges for diagnosis and treatment. Symptoms of schizophrenia more typically begin in middle- or late-adolescence.

Schizophrenia is one of several disorders characterized by psychotic symptoms; a full evaluation at the onset of symptoms can help to clarify diagnosis and ensure the administration of appropriate treatment.

 Symptoms

Psychotic symptoms, including hallucinations (the experience of hearing, seeing, tasting, smelling, or feeling something that is not actually there) and delusions (thought disturbances in which the person maintains a false belief despite the absence of proof) can develop gradually or suddenly. Symptoms of childhood-onset schizophrenia may include delays in language, poor motor development, unusual crawling, rocking, posturing, and arm flapping. Symptoms of adolescent-onset schizophrenia are more likely to include increased anxiety, depression, irritability and disruptiveness, in addition to withdrawal from family and peers, diminished academic and cognitive performance, and trouble sleeping.

The diagnostic criteria for schizophrenia include both negative and positive symptoms. Positive symptoms of schizophrenia include hallucinations and delusions. Negative symptoms of schizophrenia typically include a lack of interest in initiating and pursuing activities (avolition), minimal speech (alogia), lack of pleasure from typically-enjoyable activities (anhedonia), and low emotional expression. Negative symptoms may become apparent when youth fail to complete daily activities, such as bathing, and withdraw from other people.

Although schizophrenia is a chronic illness, symptoms tend to follow an episodic course, especially early on. With treatment, symptoms may remit (positive symptoms are often more responsive to treatment than negative symptoms) resulting in periods of relative wellness.

Treatment

Initiating treatment as early as possible may significantly improve a child’s long-term outcome. There are few studies of treatment for child-onset schizophrenia. Because child-onset schizophrenia is often associated with significant developmental abnormalities, these youth are likely to require intensive services to assist with both mental health and daily functioning.

Treatment guidelines for adolescents with psychotic symptoms recommend both medication and psychosocial interventions. There are early-treatment programs for psychotic disorders nationwide (http://www.raiseetp.org/forfamilies/participate.cfm) that provide both medication and psychosocial interventions. These multimodal programs have the strongest evidence base and include components of the other interventions that have been tested through randomized clinical trials, including family therapy, individual cognitive therapy, academic and job support, and social skills training. Schizophrenia affects multiple domains of functioning and a more comprehensive approach to treatment offers the best chance at reducing the consequences of this illness.

Other interventions with strong empirical support include family-focused therapy, cognitive behavior therapy for psychosis, special services at school to maintain academic functioning, and social services, such as vocational skills training.

The use of antipsychotic medications is also recommended for most children and adolescents with schizophrenia or other psychotic disorders. You can read more about this here: https://www.jaacap.org/article/S0890-8567(09)62600-9/pdf

 

Level one

Multimodal therapy (includes components of many of the other therapies for psychotic disorders)

Family-focused therapy

CBT for psychosis

Level two

Employment/Education programs

Level three

Omega-3 fatty acids supplementation

Level four

Social skills training

Level five

Insight-oriented therapies

References

Abidi, S (2013) Psychosis in Children and Youth: Focus on Early-Onset Schizophrenia Pediatrics in Review,34(7), 296-306 doi:101542/pir34-7-296

Chan, V, MD (2017) Schizophrenia and Psychosis: Diagnosis, Current Research Trends, and Model Treatment Approaches with Implications for Transitional Age Youth Child and Adolescent Psychiatric Clinics of North America,26(2), 341-366 doi:https://doiorg/101016/jchc201612014

Hayes, D, & Kyriakopoulos, M (2018) Dilemmas in the treatment of early-onset first-episode psychosis Therapeutic Advances in Psychopharmacology,8(8), 231-239 doi:101177/2045125318765725

Kane, J. M., Schooler, N. R., Marcy, P., Correll, C. U., Brunette, M. F., Mueser, K. T., . . . Robinson, D. G. (2015). The RAISE early treatment program for first-episode psychosis: background, rationale, and study design. J Clin Psychiatry, 76(3), 240-246. doi:10.4088/JCP.14m09289

Krause, M, Zhu, Y, Schneider-Thoma, J, Huhn, M, Salanti, G, Chaimani, A, & Leucht, S (2017) Efficacy, acceptability, and tolerability of antipsychotics in children and adolescents with schizophrenia: A network meta-analysis European Neuropsychopharmacology,27. doi:101016/s0924-977x(17)31677-2

Lecomte, T., Abidi, S., Garcia-Ortega, I., Mian, I., Jackson, K., Jackson, K., & Norman, R. (2017). Canadian Treatment Guidelines on Psychosocial Treatment of Schizophrenia in Children and Youth. Can J Psychiatry, 62(9), 648-655. doi:10.1177/0706743717720195

Marshall M, Rathbone J. Early intervention for psychosis. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD004718. DOI: 10.1002/14651858.CD004718.pub3

McClellan, J., & Stock, S. (2013). Practice Parameter for the Assessment and Treatment of Children and Adolescents With Schizophrenia. Journal of the American Acadey of Child & Adolescent Psychiatry, 52(9), 976-990. doi:10.1016/j.jaac.2013.02.008

McGorry, P. D. (2009). Intervention in individuals at ultra-high risk for psychosis: a review and future directions. The Journal of Clinical Psychiatry, 70(9), 1206-1212. doi:10.4088/JCP.08r04472

Sommer, I E, Bearden, C E, van Dellen, E, Breetvelt, E J, Duijff, S N, Maijer, K, … Vorstman, J A (2016) Early interventions in risk groups for schizophrenia: what are we waiting for? NPJ Schizophrenia, 2, 16003– http://doiorg/101038/npjschz20163

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