Pediatric schizophrenia (childhood onset schizophrenia)

Pediatric schizophrenia (childhood onset schizophrenia)

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  Pediatric schizophrenia childhood-onset schizophrenia (COS) By :Dr/Zeinab El Nagar Lecturer Of Psychiatry Ain Shams University
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  childhood-onset schizophrenia A typeof mental disorder that is characterized by degeneration of thinking, motor, and emotional processes in children and young adults under the age of 18. Schizophrenia is rare in children under the ages of 7–8 years old (Nordqvist & Christian 17 June 2010).
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  By the 1960s,"childhood schizophrenia" became known as dementia infantilis. Only about 4% of total cases of schizophrenia occur in children under fifteen and only 0.1–1% occur in children under the age of ten. Diagnosis is usually based on behavior observed by caretakers (Wicks-Nelson et al., 2009).
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  The DSM IVcriteria used to diagnose schizophrenia in adults can be used to diagnose schizophrenia in children. If there is a history of autism spectrum disorder or other communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are also present for at least 1 month DSM V } (Tandon A et al., march 2013 ).
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  The prodromal phase,which precedes psychotic symptoms, is characterized by: • deterioration in school performance, social withdrawal. • disorganized behavior. • deterioration in self-care skills. • changes in affect. • lack of impulse control ,hostility and aggression, and lethargy.
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  Most research hasconcluded that auditory hallucinations are the most common positive symptom in children. but these are often difficult to differentiate from just normal imagination or child play. A child’s auditory hallucinations may include voices that are conversing with each other or speaking directly to the children themselves (Masi G etal ., 2006).
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  Many children believethat if they do not listen to the voices, they will harm them or someone else, e.g stares are scary things— snakes, spiders, shadows—that aren't really there. Some children engage in activities such as flapping the arms or rocking, and may appear anxious or confused.
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  Delusions in childhoodexceed exaggerated magic beliefs, are often frightening and makes child to take an irrational action .
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  The cognitive abilitiesof children with schizophrenia are lag in language, motor development and showing borderline or mental retardation. Such problems tend to be associated with more brain abnormalities. (MRI) scans revealed fluid filled cavities in the brain suggesting a shrinkage in brain tissue volume.These children lost four times of gray matter and neurons in their frontal lobes. (Thompson P et al ., 2006)
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  Schizophrenia and autism Thediagnosis of schizophrenia was often given to children who would be diagnosed as having of autism or pervasive developmental disorder. until DSM-II included children with autism under the diagnostic umbrella of schizophrenia, childhood type. study results suggest that there are both clinical and biological links between autism and schizophrenia. The question regarding whether there is phenotypic overlap or co-morbidity .
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  Unique features includedlower gray matter volume in the amygdala, caudate, and frontal and medial gyrus for schizophrenia, and lower gray matter volume in the putamen for autism. schizophrenia is differentiated from autism by the persistence of hallucinations and delusions for at least 6 months.  It‘s age of onset—7 years or older. Autism is usually diagnosed by age 3 (Yael Dvir MD et al ., 2011).
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  Shared clinical features Socialwithdrawal, communication impairment, and poor eye to eye contact . When higher intelligence autistics are stressed, they become highly anxious and may appear thought- disordered. children with COS are noted with language delays and transient motor stereotypes.
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  Schizophrenia is alsomust differentiated from a type of brief psychosis and dissociative disorders in children.
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  Mangment of COS successfulmultimodal interventions: • Psychopharmacologic: For example, Rispiridone, aripipazole, quetiapine and Olanzapine. • Psychosocial interventions: for social and family relationship. Also social skills training for enhancing communication and vocational skills. • Psychoeducation: helps the patient and his family to understand the illness, treatment options, prognosis and reduce relapse .
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  OUTCOME OF COS Ingeneral, the earlier the onset of COS, the poorer the prognosis. Better prognoses of COS are higher among premorbid higher intelligence, more positive than negative symptoms of schizophrenia and cooperation of family in treatment.
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  Thank you