SCHIZOPHRENIA

What is Schizophrenia?

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

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

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

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

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

Characteristic Symptoms: Two or more of the following present for a

significant portion of time during a 1 month period (less if successfully
treated):

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:

Paranoid type
Disorganized type
Catatonic type
Undifferentiated type
Residual type

Epidemiology

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

Substance abuse disorder

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

Obsessive-Compulsive disorder

Depression

7.8% with schizophrenia had OCD

26% out of 50 patients met criteria for OCD

25% prevalence rate with Schizophrenia

Suicide

10% of patients commit suicide

Suicide attempts are 5 times higher than suicide rate

Comorbidity

Other comorbid disorders

Social phobia
Generalized anxiety
Avoidant personality disorder
Eating disorder
Conduct disorder

Etiology

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)

Etiology cont

Evidence of prenatal and biological factors that

lead to Schizophrenia.

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.

Developmental Pathways

First psychotic break in childhood

often is followed by multiple other
breaks throughout life.
After the disorder develops, more
noticeable complications arise:

Social isolation
Economic impairment
Academic deficits

Developmental Pathways

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

Medication: atypical antipsychotics

Olanzapine
Clozapine
Used to reduce symptoms such hallucinations
and delusions
New medicines help reduce chance of tardive
dyskinesia

Treatment

Side effects of medication:

Weight gain
Blood disorder (agranulocytosis)
Nausea
Urinary retention
Impotence
Hyper salivation
Dyskinesia
Depression

Treatment

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 patients developmental history, the mother had pregnancy complications with insulindependant 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 boys 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 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 patients schizophrenia. Certainly more
research needs to be conducted, but this is very good start.