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Overview

Childhood schizophrenia is an uncommon but severe mental disorder and is same as in adults. It has a profound impact on a child's behavior and development. Identifying and starting treatment for childhood schizophrenia as early as possible may significantly improve child's long-term outcome. Schizophrenia involves a range of problems with thinking, behavior or emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized behaviour, and reflect an impaired ability to function.

Schizophrenia symptoms generally start in the mid- to late 20s. Early-onset schizophrenia is defined as schizophrenia with onset of clear positive symptoms prior to 18 years of age. Very early-onset schizophrenia with onset between ages 13 to 18 is called adolescent onset. Onset of illness prior to13 is known as very early onset or childhood onset.


How to recognize

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Schizophrenia can be difficult to recognize in the early phases.

  1. Premorbid signs and symptoms
  2. The earliest indications of childhood schizophrenia may include developmental problems, such as:

    • Being odd and socially isolated or having multiple generally mild developmental delays in cognitive, motor, sensory and social functioning like
      • Language delays
      • Late or unusual crawling
      • Late walking
    • Changes in functioning and behavior that have occurred over the past 3 to 4 years
    • Other abnormal motor behaviors — for example, rocking or arm flapping.

    So ruling out these developmental disorders is one of the first steps in diagnosis of childhood schizophrenia from developmental disorder.

  3. Symptoms in teenagers
  4. Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be more difficult to recognize in this age group. Clinicians are frequently reluctant to diagnose childhood schizophrenia even when clear evidence of the disorder with reasons of concerns about over labeling, likely poor outcome and associated stigma. Failure to make diagnosis and appropriate interventions and psycho education could lead to longer duration of untreated psychosis, result in poor prognosis of illness.

    The common symptoms of teenagers are like that they

    • Have poor communication and interaction with friends and family.
    • Have academic deterioration.
    • Have non-specific symptoms such as poor attention and increased aggression.
    • Have sleep disturbances.
    • Remain depressed or irritated.
    • Have Lack of motivation.
    • Show strange erratic behavior.
    • Start Substance use.
    • Less likely to have delusions
    • More likely to have visual hallucinations as compared with adult schizophrenia

  5. Later signs and symptoms
  6. With progression of age, more typical signs and symptoms of the disorder begin to appear. Signs and symptoms may include:

    • Delusions. These are firm, false, fixed beliefs that are not related to reality, like delusion of persecution.
    • Hallucinations. These are false perception about seeing or hearing things that don't exist, like auditory hallucination, visual hallucination.
    • Disorganized Behaviour. Includes disorganized speech, erratic behavior, poor hygiene, abnormal movement.
    • Negative symptoms. These include reduced or lack of ability to function that a normal person have in their life, like lack of empathy, low interest, low pleasurable activities.

  7. Behavioural Observation
  8. These general signs symptoms and behaviours are merely indicators of childhood schizophrenia, another psychiatric disorder like depression, anxiety can be possible reason.

    • Child has developmental delays compared with other siblings or peers.
    • Deteriorating daily activities like bathing, dressing, eating pattern, playing.
    • Doesn’t want to socialize.
    • Deterioration in academic performance.
    • Has started suspicion over family, friends and others.
    • Has difficulties in emotional expression or has inappropriate emotion.
    • Has bizarre ideas, behavior or speech.
    • Has violent or aggressive behavior or agitation, remain irritable and has episodes of aggressive behavior.
    • Suicidal thoughts and behavior are common among people with schizophrenia.

Etiology

A combination of genetics, brain chemistry like disturbances in neurotransmitters, dopamine and glutamate, may contribute to schizophrenia and environment contributes to development of the disorder.


Consequences

The long-term untreated schizophrenia may lead to

  • Suicide, suicide attempts and thoughts of suicide
  • Abuse of alcohol or other drugs, including tobacco
  • Family conflicts
  • Inability to attend school or work or live independently.
  • Social isolation.
  • Health and medical problems.
  • Legal and financial problems and homelessness.
  • Aggressive behavior, although uncommon

Prevention

Early identification and treatment may help to get symptoms of childhood schizophrenia under control before serious complications develop.


Treatment
  • Proper diagnosis and early intervention can help child’s long term outlook.
  • Medications
    • Anti Psychotic medicine
    • The modern Anti Psychotics are very effective and have minimal side effects.
    • Myths about treatment:
      • Habit forming
      • Medicine runs lifelong
      • These are Sedative medicines

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