Psychiatry Notes- Childhood Schizophrenia

CHILDHOOD ONSET SCHIZOPHRENIA

CLASSIFICATION:
Very early onset- before 13 yrs of age, Insidious Onset
Early onset , -before 18 years.Acute to subacute onset, i.e within one year

SYMPTOMS
Hallucinations, There are more of hallucinations, both visual and auditory. Misreprentation of normal intrapsychic experience, imagination, dissociative experiences or plainly not understanding the examiner’s question.
Thought Disorder- Commonly seen, Rule out developmental delays or Language disorders.
Flattened affect – common

Generally when evaluating a child for Schizophrenia the child’s age has to be taken into account. The child at the earlier years before age of 7 – 8 may have fantasy friends, this may generally not be of concern to the parents.
If the child demonstrates strange experiences after that age, especially voices passing derogatory remarks, or conversing with each other or seeing scary visual images as well as a decline in their social interaction, esp. staying away from friends, then this may be suggestive of signs of schizophrenia. Remember that since the child’s cognitive framework has not developed well it is very rare that you find them having well systematized delusions. They generally comprise childhood themes.
Incidence: 1 in 40,000, compared to 1 in 100 in adults.

Differential Diagnosis:
Mood Disorders: 50% bipolar chlldren originally diagnosed as schizophrenia
Increased family history of depression in young schizophrenics

Schizoaffective Disorder

Nonpsychotic Behavioural Disorders- they have lower rrates of delusions & thought
disorder. Children who have been victims of abuse may sometimes claim to hear voices of or see visions of the abuser.

Pervasive Developmental Disorder:Earlier age of Onset (Schiz- age of onset 7 years or older) Autism is usually diagnosed by age 3yrs
No normal period of development
Generally lack of hallucinations and delusions
Deviant language patterns
Problems with social relating

Language and Speech Disorders: May mimic thought disorders
Organicity: R/O Seizure Disorder
CNS Lesions- head trauma, tumors
Delirium
Neurodegenerative Disorders- Huntington’s, Lipid Storage, etc

Medications: Amphetamines, Anticholinergics

Metabolic- Wilson’s

Prognosis is poor as compared to adult onset schizophrenia.

The newer generation "atypical" antipsychotics, such as olanzapine and clozapine, may also help improve motivation and emotional expressiveness in some patients. They also have a lower likelihood of producing disorders of movement, including tardive dyskinesia, than the other antipsychotic drugs such as haloperidol. However, even with these newer medications, there are side effects, including excess weight gain that can increase risk of other health problems.
Families can also benefit from supportive counseling, psychotherapies and social skills training aimed at helping them cope with the illness. They likely require special education and/or other accommodations to succeed in the classroom.