CHILD HOOD SCHIZOPHRENIA

I. INTRODUCTION
Childhood schizophrenia is an uncommon but severe mental disorder in which
children interpret reality abnormally. Schizophrenia involves a range of problems with
thinking (cognitive), behavior or emotions. It may result in some combination of
hallucinations, delusions, and extremely disordered thinking and behavior that impairs
your child's ability to function.
Childhood schizophrenia is essentially the same as schizophrenia in adults, but it
occurs early in life and has a profound impact on a child's behavior and development.
With childhood schizophrenia, the early age of onset presents special challenges for
diagnosis, treatment, education, and emotional and social development. Schizophrenia
is a chronic condition that requires lifelong treatment. Identifying and starting treatment
for childhood schizophrenia as early as possible may significantly improve your child's
long-term outcome.
II. DEFINITION
childhood schizophrenia (also known as childhood-onset schizophrenia, and very
early-onset schizophrenia) is a schizophrenia spectrum disorder that is characterized
by hallucinations, disorganized speech, delusions, catatonic behavior and "negative
symptoms", such as inappropriate or blunted affect and avolition with onset before 13
years of age.
III. INCIDENCE
Childhood schizophrenia is a rare illness among children in the general population;
among children with mental illness, only about 2 in every 1000 have childhood
schizophrenia
IV. ETIOLOGY
 No definite single etiology of schizophrenia has been identified. Most theories
accept both genetic and environmental contributions for the causation of
childhood-onset schizophrenia.
 Mostly childhood psychotic symptoms are familial and heritable. These symptoms
are associated with social risk factors; cognitive impairments at age 5 years; home-
rearing risk factors; behavioral, emotional, and educational problems at age 5 years;
and comorbid conditions such as self-harm. Therefore, childhood psychotic
disorders may be a marker of an impaired developmental process.
 In addition, compared with the usual onset of schizophrenia in late adolescence or
early adulthood, the emergence of earlier-onset schizophrenia during childhood may
 be due to increased genetic loading for schizophrenia or early central nervous
system (CNS) damage due to an environmental factor.
V. RISK FACTORS

Although the precise cause of schizophrenia isn't known, certain factors seem to
increase the risk of developing or triggering schizophrenia, including:

 Having a family history of schizophrenia

 Increased immune system activation, such as from inflammation or autoimmune
diseases
 Older age of the father
 Some pregnancy and birth complications, such as malnutrition or exposure to toxins
or viruses that may impact brain development
 Taking mind-altering (psychoactive or psychoactive) drugs during teen years.

VI. PATHOPHYSIOLOGY

Due to etiological factors such as genetic /environmental,social,psychological factors

result in neurodevelopmental abnormalities and target features often result in brain
dysfunction, improper balance of chemicals leads to schizophrenia.
VII. CLINICAL MANIFESTATION
The earliest indications of childhood schizophrenia may include developmental problems,
such as:

 Language delays
 Late or unusual crawling
 Late walking
 Other abnormal motor behaviors — for example, rocking or arm flapping

Some of these signs and symptoms are also common in children with pervasive
developmental disorders, such as autism spectrum disorder. So ruling out these
developmental disorders is one of the first steps in diagnosis.

Symptoms in teenagers

Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may
be more difficult to recognize in this age group. This may be in part because some of the
early symptoms of schizophrenia in teenagers are common for typical development during
teen years, such as:

 Withdrawal from friends and family

 A drop in performance at school
 Trouble sleeping
 Irritability or depressed mood
 Lack of motivation
 Strange behavior
 Substance use

Compared with schizophrenia symptoms in adults, teens may be:

 Less likely to have delusions

 More likely to have visual hallucinations
 Later signs and symptoms

As children with schizophrenia age, more typical signs and symptoms of the disorder
begin 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; that certain gestures or comments are directed
to the child; that child have exceptional ability or fame; that another person is in love
with child; or that a major catastrophe is about to occur. Delusions occur in most
people with schizophrenia.
 Hallucinations. These usually involve seeing or hearing things that don't exist. Yet
for the person with schizophrenia, hallucinations have the full force and impact of a
normal experience. 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 may show in several
ways, from childlike silliness to unpredictable agitation. Behavior is not focused on a
goal, which makes it hard to do tasks. Behavior can include resistance to instructions,
inappropriate or bizarre posture, a complete lack of response, or useless and excessive
movement.
 Negative symptoms. This refers to reduced or lack of ability to function normally.
For example, the person may neglect personal hygiene or appear to lack emotion ―
doesn't make eye contact, doesn't change facial expressions, speaks in a monotone, or
doesn't add hand or head movements that normally occur when speaking. Also, the
person may have reduced ability to engage in activities, such as a loss of interest in
everyday activities, social withdrawal or lack ability to experience pleasure.
VIII. . DIAGNOSTIC EVALUATION

Diagnosis of childhood schizophrenia involves ruling out other mental health

disorders and determining that symptoms aren't due to substance abuse, medication or a
medical condition. The process of diagnosis may involve:
  Physical exam. This may be done to help rule out other problems that could be
causing symptoms and to check for any related complications.
 Tests and screenings. These may include tests that help rule out conditions with
similar symptoms, and screening for alcohol and drugs. The doctor may also request
imaging studies, such as an MRI or CT scan.
 Psychological evaluation. This includes observing appearance and demeanor, asking
about thoughts, feelings and behavior patterns, including any thoughts of self-harm
or harming others, evaluating ability to think and function at an age-appropriate level,
and assessing mood, anxiety and possible psychotic symptoms. This also includes a
discussion of family and personal history
IX. MANAGEMENT
Schizophrenia in children requires lifelong treatment, even during periods when
symptoms seem to go away. Treatment is a particular challenge for children with
schizophrenia. The team approach may be available in clinics with expertise in
schizophrenia treatment. The team may include Psychiatrist, psychologist or other
therapist, psychiatric nurse, social worker, family members, pharmacist, case manager to
coordinate care.
 PHARMACOLOGICAL MANAGEMENT

Most of the antipsychotics used in children are the same as those used for adults with
schizophrenia. Antipsychotic drugs are often effective at managing symptoms such as
delusions, hallucinations, loss of motivation and lack of emotion.

In general, the goal of treatment with antipsychotics is to effectively manage

symptoms at the lowest possible dose. Depending on the symptoms, other medications also
may help, such as antidepressants or anti-anxiety drugs. It can take several weeks after
starting a medication to notice an improvement in symptoms.

Second-generation antipsychotics

Newer, second-generation medications are generally preferred because they have

fewer side effects than do first-generation antipsychotics. However, they can cause weight
gain, high blood sugar, high cholesterol and heart disease.

Examples of second-generation antipsychotics approved by the Food and Drug

Administration (FDA) to treat schizophrenia in teenagers age 13 and older include:
  Aripiprazole (Abilify)
 Olanzapine (Zyprexa)
 Quetiapine (Seroquel)
 Risperidone (Risperdal)

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

First-generation antipsychotic

These first-generation medications are usually as effective as second-generation

antipsychotics in controlling delusions and hallucinations. In addition to having side effects
similar to those of second-generation antipsychotics, first-generation antipsychotics also
may have frequent and potentially significant neurological side effects. These can include
the possibility of developing a movement disorder (tardive dyskinesia) that may or may
not be reversible. Because of the increased risk of serious side effects with first-generation
antipsychotics, they often aren't recommended for use in children until other options have
been tried without success.

Examples of first-generation antipsychotics approved by the FDA to treat

schizophrenia in children and teens include:

 Chlorpromazine for children 13 and older

 Haloperidol for children 3 years and older
 Perphenazine for children 12 years and older
First-generation antipsychotics are often cheaper than second-generation
antipsychotics, especially the generic versions, which can be an important consideration
when long-term treatment is necessary.

 PSYCHOTHERAPY

In addition to medication, psychotherapy, sometimes called talk therapy, can help

manage symptoms and help the child to cope with the disorder. Psychotherapy may
include:
  Individual therapy. Psychotherapy, such as cognitive behavioral therapy, with a
skilled mental health professional can help the child to learn ways to deal with the
stress and daily life challenges brought on by schizophrenia. Therapy can help
reduce symptoms and help the child make friends and succeed at school. Learning
about schizophrenia can help the child to understand the condition, cope with
symptoms and stick to a treatment plan.
 Family therapy. The child and family may benefit from therapy that provides
support and education to families. Involved, caring family members who understand
childhood schizophrenia can be extremely helpful to children living with this
condition. Family therapy can also help the child and family to improve
communication, work out conflicts and cope with stress related to child’s condition.
 LIFE SKILLS TRAINING

Treatment plans that include building life skills can help child function at age-appropriate
levels when possible. Skills training may include:

 Social and academic skills training. Training in social and academic skills is an
important part of treatment for childhood schizophrenia. Children with
schizophrenia often have troubled relationships and school problems. They may
have difficulty carrying out normal daily tasks, such as bathing or dressing.
 Vocational rehabilitation and supported employment. This focuses on
helping people with schizophrenia prepare for, find and keep jobs
X. NURSING MANAGEMENT
 Nursing of psychotic children is a highly specialized area. However the nurses
should be alert to the possibility that schizophrenia can occur in children and refer
children who consistently demonstrate abnormal behavior to a psychiatrist for
evaluation.
 In addition nurses need to teach family members of children taking antipsychotic
drugs to observe for possible sideeffects.common side effect of the child include
dizziness, drowsiness, tachycardia, hypotension and extra pyramidal effects such
as abnormal movement and seizure.
 Advice the family members to check first with consultant before giving other
medication such as over-the-counter medications, vitamins, minerals, herbs or
other supplements. These can interact with schizophrenia medications.
 Make physical activity and healthy eating a priority. Some medications for
schizophrenia are associated with an increased risk of weight gain and high
 cholesterol in children. Work with child's doctor to make a nutrition and physical
activity plan for child that will help manage weight and benefit heart health.
 Avoid alcohol, street drugs and tobacco. Alcohol, street drugs and tobacco can
worsen schizophrenia symptoms or interfere with antipsychotic medications.
Advice to the child about avoiding drugs and alcohol and not smoking.
 Coping and support should be given to the child and family members through
 Learn about the condition. Education about schizophrenia can empower
child and family member to motivate him or her to stick to the treatment
plan. Education can help friends and family understand the condition and
be more compassionate with child.
 Join a support group. Support groups for people with schizophrenia can
help to reach out to other families facing similar challenges.
 Get professional help. If you as a parent or guardian feel overwhelmed
and distressed by your child's condition, consider seeking help from a
mental health professional.
 Stay focused on goals. Dealing with childhood schizophrenia is an
ongoing process. Stay motivated as a family by keeping treatment goals in
mind.
 Find healthy outlets. Explore healthy ways your whole family can channel
energy or frustration, such as hobbies, exercise and recreational activities.
 Take time as individuals. Although managing childhood schizophrenia is
a family affair, both children and parents need their own time to cope and
unwind. The nurse should create opportunities for healthy alone time.
 Begin future planning. Ask about social service assistance. Most
individuals with schizophrenia require some form of daily living support.
Many communities have programs to help people with schizophrenia with
jobs, affordable housing, transportation, self-help groups, other daily
activities and crisis situations..
XI. PREVENTION

Early identification and treatment may help get symptoms of childhood schizophrenia
under control before serious complications develop. Early treatment is also crucial in
helping limit psychotic episodes, which can be extremely frightening to a child and his or
her parents. Ongoing treatment can help improve your child's long-term outlook.
XII. COMPLICATIONS

Left untreated, childhood schizophrenia can result in severe emotional, behavioral and
health problems. Complications associated with schizophrenia may occur 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
 Abuse of alcohol or other drugs, including tobacco
 Family conflicts
 Inability to live independently, attend school or work
 Social isolation
 Health and medical problems
 Being victimized
 Legal and financial problems, and homelessness
 Aggressive behavior, although uncommon
XIII. RESEARCH ABSTRACT
 Childhood-Onset Schizophrenia: History of the Concept and Recent Studies
Helmut E. Remschmidt, M.D. Eberhard Schulz, M.D. Matthias Martin, M.D.Andreas
Warnke, M.D. Götz-Eric Trott, M.D.
Schizophrenia Bulletin, Volume 20, Issue 4, 1 January 1994, Pages 727–745
Published:01 January 1994
ABSTRACT:
Schizophrenic disorders in childhood are rare: 0.1–1 percent of all schizophrenic
disorders manifest themselves before age 10, and 4 percent before age 15. There is,
however, a remarkable increase in schizophrenia during adolescence. Age and
developmental stage also influence symptoms, course, and outcome. The evidence for a
male preponderance in the very early-onset group (< 14) does not apply for adolescents
over age 14. The presence of positive and negative precursor symptoms can be
demonstrated in child and adolescent schizophrenia before the first clinical manifestation
leading to inpatient treatment. With regard to pharmacologic treatment, atypical
neuroleptics such as clozapine can be used successfully. As to outcome, schizophrenic
psychoses with early manifestation have a poor prognosis. The patients' premorbid
personality also seems to be of great importance: A poor prognosis can be found in patients
who were cognitively impaired, shy, introverted, and withdrawn before the beginning of
their psychotic state.