Childhood Onset Schizophrenia

1. Childhood Onset Schizophrenia By: Jasmine Figg & Megan Horner

2. COS vs. AOS • In adults schizophrenia is characterized by an acute psychotic episode • In children it appears gradually • Diagnosis is the same as for adults except that symptoms appear before the age of 12 instead of the late teens/early 20’s. • NIMH found more severe chromosomal abnormalities in children than in adults.

3. Facts • Childhood onset schizophrenia (COS) is a mysterious disease that is very rare and not well researched. • The NIMH (National Institute of Mental Health) reviewed 1300 charts and only found 50 subjects with COS. • The NIMH does not advocate diagnosing COS under the age 7, they instead categorize them as suffering from Autism or brain damage. • 50% of children suffering from COS have at least one first degree relative with schizophrenia.

4. Facts • Incidence of COS is less than 1 in 10,000 births • 80% of COS patients have hallucinations and 50% have delusions. • It is diagnosed more in males than females • Treatment using only medication is not as effective as medication combined with other forms. • Most children suffering from COS have a normal range IQ

5. Symptoms • Symptoms of COS are classified in two categories-Positive and Negative • Positive Symptoms: hallucinations, paranoid and bizarre beliefs (think people are plotting against them) • Negative Symptoms: attention problems, impaired speech, poor language development, memory, and reasoning, inappropriate of flat expression of emotion (laugh at sad events), poor social and personal care skills, depressed mood, poor eye contact, and show little body language. • Generally the symptoms of schizophrenia pervade the child's life and are not limited to just certain situations. • If children show ANY interest in friendships they are NOT suffering from schizophrenia.

6. Common Misdiagnosis • Often confused with Autism because many symptoms overlap. • Distinguished from Autism by presence of delusions and hallucinations for at least 6 months and a later age of onset, 7 years or older (Autism is usually diagnosed by age 3) • Can also be confused with personality and dissociative disorders in children. • Adolescence with Bipolar disorders often have acute onset of manic episodes that are sometimes mistaken for COS. • Children who are victims of abuse may claim to hear voices or see visions of their abuser.

7. Treatment • There is no cure for Schizophrenia however symptoms are manageable with treatment. • Treatment includes 3 different interventions: Biological, Educational, and Social. • Medication is the cornerstone of treatment however it is used more to manage symptoms and must be accompanied by psychological and social interventions to control the disease effectively. • In the last decade alone there are a number of new drugs (antipsychotic) that produce less side effects. • Antipsychotic can sometimes take weeks or months to begin working • Two common antipsychotic medications prescribed are: Olanzapine (Zyprexa) and Clozapine (Clorazil). • Haloperidol is not longer the best form antipsychotic medication because it induces tardive dyskinesia (they have jerky movements) • Even with these new medications there are side effects: excess weight gain.

8. Causes • The causes of schizophrenia are still under investigation. We currently do not fully understand this disease. • Evidence suggests that it is a neurobiological disease with a genetic predisposition. • There is new evidence that suggests that a contributing factor to COS is a prenatal injury to the brain. • viral infections, such as maternal flu in the second trimester, starvation, lack of oxygen at birth, and untreated blood type incompatibility. • Children share the same abnormal brain structure that is present in adults with schizophrenia. However, the abnormalities in children tend to be more severe then in adults. • One study by the NIMH suggests that MRI scans reveal COS patients have fluid filled cavities which suggests a significant loss of grey matter over time.

10. Research Findings • Since 1990 there has been an ongoing study at the NIMH. These findings are based on the treatment of 49 patients that did not respond to conventional therapy. • 55% had language abnormalities, 57% had motor abnormalities, 55% had social abnormalities and 63.6% either failed a grade or required placement in special education. • Overall poor neuropsychological functioning in attention, working memory and executive function. • Findings indicate a more severe early disruption of brain development in patients with COS. This indicates a greater likelihood of genetic inheritance.

11. Evaluating the child: It is essential that when a child is being evaluated that it is done by a professional specifically trained and skilled at evaluating, treating, and diagnosing children and adolescence with mental health disorders. It is important for parents/guardians to make a list of questions they have and keep a record of their child’s behavior, symptoms, and reports from school personnel. Diagnosis

12. Dealing with COS • It is important to talk to the child as well as the siblings after the diagnosis is made. • It is important for the parent/guardian to have a good understanding of the disease before they can openly address their children’s questions and fears. • Always answer the child’s questions honestly. • Never avoid the subject • Use positive, hopeful language they will understand • Must also talk to the siblings and help them understand. When the siblings are old enough explain that schizophrenia is a partly genetic disorder and talk to them about the possibilities of inheritance regarding having children of their own someday. Schizophrenia Society of NS.

13. References Yates, M. (2004). Childhood Onset Schizophrenia. Retrieved October, 24th 2005 <http://www.schizophrenia.com/family/childonsetov.htm> Kamajian, A. (2004). The Brain in Schizophrenia. Retrieved November 5th 2005. <http://www.mindcontrolforums.com/news/schizophrenia3a.gif> (2005). Childhood Onset Schizophrenia, retrieved October 24th, 2005 <http://www.schizophrenia.com/family/childszsym.htm> Lott, A.D (1999). Childhood onset schizophrenia: latest NIMH findings, Psychiatric Times, vol 14(9). Mental Health Association in Texas (2005). Childhood Onset Schizophrenia pamphlet. Bobb et al. (2005), Lack of Evidence for Elevated Obstetric Complications in Childhood Onset Schizophrenia, Biological Psychiatry 58:10–15 Psychology in the Schools(2004). Childhood onset schizophrenia: Overview, Published online in Wiley InterScience www.interscience.wiley.com).

14. References Gochman et al. (2005). IQ stabilization in childhood-onset schizophrenia, Schizophrenia Research, 02404, 1-7. Sharma, I (2005). Psychosis in Children: What is our present state of knowledge, Editorial JIACAM, 1(2), 1 NIMH (2004). Facts About: Child Onset Schizophrenia (an update). Department of Health and Human Services, National Institute of Health. 1-5. Rapoport, J. (1999). Progressive Cortical Change During Adolescence in Childhood-Onset Schizophrenia, American Medical Association, (56)1, 649-654. Röpcke, B. & Eggers, C. (2005). Early-onset schizophrenia: A 15-year follow-up, European Child Adolescence Psychiatry, 14, 341-350. Nicolson, R & Rapoport, J. (2005). Review: Childhood-Onset Schizophrenia: Rare but Worth Studying, Biological Psychiatry, 1425 (46) 1418–1428