SCHIZOPHRENIA

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SCHIZOPHRENIA

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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.

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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

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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

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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!

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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

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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

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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 21 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

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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

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Comorbidity

• Obsessive-Compulsive disorder
• 7.8 with schizophrenia had OCD
• 26 out of 50 patients met criteria for OCD
• Depression
• 25 prevalence rate with Schizophrenia
• Suicide
• 10 of patients commit suicide
• Suicide attempts are 5 times higher than suicide
  rate

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Comorbidity

• Other comorbid disorders
• Social phobia
• Generalized anxiety
• Avoidant personality disorder
• Eating disorder
• Conduct disorder

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Etiology

• Strong evidence of genetic component to
  development of Schizophrenia.
• The stronger the genetic compatibility between
  individuals, the higher the concordance rates.
  Cont

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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)

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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

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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.

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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

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Developmental Pathways

• Long term prognosis is generally related to age
  of onset. (Earlier onsetpoorer prognosis)
• Childhood onset usually continues throughout
  adulthood.
• Full recovery is rare.
• Best hope is remission from active symptoms
  through intensive therapeutic interventions and
  psychopharmacology.

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Treatment

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

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Treatment

• Side effects of medication
• Weight gain
• Blood disorder (agranulocytosis)
• Nausea
• Urinary retention
• Impotence
• Hyper salivation
• Dyskinesia
• Depression

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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

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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 insulin-dependant 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 ½ 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.