Childhood schizophrenia

File:DSM-III-Remove-ChildhoodSchiz.png against childhood schizophrenia.]]

Childhood schizophrenia was not directly added to the DSM until 1968, when it was added to the DSM-II,{{cite book|title=Diagnostic and Statistical Manual of Mental Disorders, 2nd Edition|date=1968|location=Washington, D. C.|page=35|author=American Psychiatric Association |isbn=978-0-89042-035-5 |url=https://dsm.psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890420355.dsm-ii|doi=10.1176/appi.books.9780890420355.dsm-ii|doi-broken-date=1 November 2024}} which set forth diagnostic criteria similar to that of adult schizophrenia.{{cite journal | vauthors = Remschmidt HE, Schulz E, Martin M, Warnke A, Trott GE | title = Childhood-onset schizophrenia: history of the concept and recent studies | journal = Schizophrenia Bulletin | volume = 20 | issue = 4 | pages = 727–45 | year = 1994 | pmid = 7701279 | doi = 10.1093/schbul/20.4.727 | doi-access = }} "Schizophrenia, childhood type" was a DSM-II diagnosis with diagnostic code 295.8, equivalent to "schizophrenic reaction, childhood type" (code 000-x28) in DSM-I (1952). "Schizophrenia, childhood type" was successfully removed from the DSM-III (1980), and in the Appendix C they wrote: "there is currently no way of predicting which children will develop Schizophrenia as adults". Instead of childhood schizophrenia they proposed to use of "infantile autism" (299.0x) and "childhood onset pervasive developmental disorder" (299.9x).{{cite book |author=American Psychiatric Association |title=Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) |location=Washington, DC |publisher=American Psychiatric Publishing |year=1980 |page=375 |chapter=Appendix C: Annotated Comparative Listing of DSM-II and DSM-lll|author-link=American Psychiatric Association }}

In the DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000), DSM-5 (2013) there is no "childhood schizophrenia". The rationale for this approach was that, since the clinical pictures of adult schizophrenia and childhood schizophrenia are identical, childhood schizophrenia should not be a separate disorder.{{cite journal | vauthors = Spitzer RL, Cantwell DP | title = The DSM-III classification of the psychiatric disorders of infancy, childhood, and adolescence | journal = Journal of the American Academy of Child Psychiatry | volume = 19 | issue = 3 | pages = 356–70 | year = 1980 | pmid = 6157706 | doi = 10.1016/s0002-7138(09)61059-1 | publisher = Elsevier BV }} However, the section in schizophrenia's Development and Course in DSM-5, includes references to childhood-onset schizophrenia.

In the International Classification of Diseases 8th revision (ICD-8, 1967) there was a category (295.8) "Other" in the schizophrenia section (295). "Other" includes: atypical forms of schizophrenia, infantile autism, schizophrenia, childhood type, NOS (Not Otherwise Specified), schizophrenia of specified type not classifiable under 295.0–295.7, schizophreniform attack or psychosis.

Unspecified psychoses with origin specific to childhood (code 299.9) in the International Classification of Diseases 9th revision (ICD-9) includes "child psychosis NOS", "schizophrenia, childhood type NOS" and "schizophrenic syndrome of childhood NOS".{{cite book |date=1977 |title=Manual of the international statistical classification of diseases injuries and causes of death |url=http://psychiatr.ru/download/1480?view=1&name=1336.pdf |location=Geneva |publisher=World Health Organization |page=190}}

"Childhood type schizophrenia" available in the Soviet adopted version of the ICD-9 (code 299.91) and the Russian adopted version of the 10th revision ICD-10 (code F20.8xx3){{cite web |url=http://ncpz.ru/lib/1/book/14/chapter/4 |title=ICD-10. Schizophrenia, schizotypal and delusional disorders (F20—F29) |language=ru |access-date=3 December 2017}} and the U.S. adopted the 10th revision ICD-10 (code F20.9x6) classified "schizophrenia, unspecified".{{Cite web|title=The ICD-10 Classification of Mental and Behavioral Disorders|url=https://www.who.int/classifications/icd/en/bluebook.pdf|url-status=live|website=World Health Organization|page=83|archive-url=https://web.archive.org/web/20041017011412/http://www.who.int/classifications/icd/en/bluebook.pdf |archive-date=2004-10-17 }}

{{Main|Schizophrenia}}

{{See also|Basic symptoms of schizophrenia}}

Schizophrenia is a mental disorder that is expressed in abnormal mental functions, a loss of one's sense of identity and self, a compromised perception of reality, and disturbed behavior.

The signs and symptoms of childhood schizophrenia are similar to those of adult-onset schizophrenia. Some of the earliest signs that a young child may develop schizophrenia are lags in language and motor development. Some children engage in activities such as flapping the arms or rocking, and may appear anxious, confused, or disruptive on a regular basis. Children may experience hallucinations, but these are often difficult to differentiate from just normal imagination or child play. Visual hallucinations are more commonly found in children than in adults. It is often difficult for children to describe their hallucinations or delusions, making very early-onset{{Cite journal|last=Jardri|first=Renaud|date=2014|title=From Phenomenology to Neurophysiological Understanding of Hallucinations in Children and Adolescents|journal=Schizophrenia Bulletin|volume=40|issue=Suppl 4 |pages=S221–S232|doi=10.1093/schbul/sbu029|pmid=24936083|pmc=4141307}} schizophrenia especially difficult to diagnose in the earliest stages. The cognitive abilities of children with schizophrenia may also often be lacking, with 20% of patients showing borderline or full intellectual disability.{{cite journal | vauthors = Masi G, Mucci M, Pari C | title = Children with schizophrenia: clinical picture and pharmacological treatment | journal = CNS Drugs | volume = 20 | issue = 10 | pages = 841–66 | year = 2006 | pmid = 16999454 | doi = 10.2165/00023210-200620100-00005 | s2cid = 41966134 }}

Negative symptoms include apathy, avolition, alogia, anhedonia, asociality, and blunted emotional affect.

• Apathy is an overall lack of interest or enjoyment, which relates to the negative symptom of blunted emotional affect.
• Blunted emotional affect includes a lack of facial expressions, lack of intonation while speaking, and little eye contact. If you are speaking to someone who has blunted emotional affect, it would be difficult to determine their feelings using their facial expressions and tone.
• Avolition is experienced when the child shows few goal-focused behaviors and choices, and a lack of interest in goal-related activities, including personal hygiene.{{Cite journal|last1=Strauss|first1=Gregory P.|last2=Horan|first2=William P.|last3=Kirkpatrick|first3=Brian|last4=Fischer|first4=Bernard A.|last5=Keller|first5=William R.|last6=Miski|first6=Pinar|last7=Buchanan|first7=Robert W.|last8=Green|first8=Michael F.|last9=Carpenter|first9=William T.|date=2013-06-01|title=Deconstructing negative symptoms of schizophrenia: Avolition–apathy and diminished expression clusters predict clinical presentation and functional outcome|journal=Journal of Psychiatric Research|language=en|volume=47|issue=6|pages=783–790|doi=10.1016/j.jpsychires.2013.01.015|issn=0022-3956|pmc=3686506|pmid=23453820}}
• Alogia can be seen when people use few words and lack fluency while speaking.
• Anhedonia relates to an inability to find pleasure in activities that one previously found enjoyable, as well as the inability to remember previous enjoyable memories.{{Cite journal|last=Gee|first=Dylan G.|date=2019-04-10|title=Demystifying anhedonia in childhood with large-scale networks|url=https://www.science.org/doi/10.1126/scitranslmed.aax1723|journal=Science Translational Medicine|volume=11|issue=487|pages=eaax1723|doi=10.1126/scitranslmed.aax1723|s2cid=111256918}}
• Asociality is a symptom seen when a person has no interest in socializing with others.{{Cite book|last=Gray|first=Susan W.|url=https://www.worldcat.org/oclc/945782115|title=Psychopathology : a competency-based assessment model for social workers|publisher=Cengage Learning|year=2016|isbn=978-1-305-10193-7|edition=4th|location=Boston, MA|oclc=945782115}}

These negative symptoms can severely impact children's and adolescents' abilities to function in school and in other public settings.

Very early-onset schizophrenia refers to onset before the age of thirteen. The prodromal phase, which precedes psychotic symptoms, is characterized by deterioration in school performance, social withdrawal, disorganized or unusual behavior, a decreased ability to perform daily activities, a deterioration in self-care skills, bizarre hygiene and eating behaviors, changes in affect, a lack of impulse control, hostility and aggression, and lethargy.

Auditory hallucinations are the most common of the positive symptoms in children. Auditory hallucinations may include voices that are conversing with each other or voices that are speaking directly to the children themselves. Many children with auditory hallucinations believe that if they do not listen to the voices, the voices will harm them or someone else. Tactile and visual hallucinations seem relatively rare. Children often attribute the hallucinatory voices to a variety of beings, including family members or other people, evil forces ("the Devil", "a witch", "a spirit"), animals, characters from horror movies (Bloody Mary, Freddy Krueger) and less clearly recognizable sources ("bad things," "the whispers"). Delusions are reported in more than half of children with schizophrenia, but they are usually less complex than those of adults. Delusions are often connected with hallucinatory experiences. Command auditory hallucinations (also known as imperative hallucinations) were common and experienced by more than half of the group in a study at Bellevue Hospital Center's Children's Psychiatric Inpatient Unit. In this study, delusions were characterized as persecutory for the most part, but some children reported delusions of control. Many said they were being tortured by the beings causing their visual and auditory hallucinations; some thought disobeying their voices would cause them harm.

Some degree of thought disorder was observed in a test group of children at Bellevue Hospital. They displayed illogicality, tangentiality (a serious disturbance in the associative thought process), and loosening of associations.{{Citation|title=Action and Thought: in-Patient Treatment of Severe Personality Disorders Within A Psychotherapeutic Milieu|date=2006-03-31|url=http://dx.doi.org/10.1201/b13290-23|work=Personality Disorder and Serious Offending|pages=181–189|publisher=CRC Press|doi=10.1201/b13290-23|isbn=978-0-429-25273-0|access-date=2021-07-02}}

Negative symptoms include apathy, avolition, and blunted emotional affect.{{citation needed|date=March 2021}}

Several environmental factors, including perinatal complications and prenatal maternal infections may contribute to the etiology of schizophrenia. Prenatal rubella or influenza infections are associated with childhood-onset schizophrenia.{{Cite journal|date=2011-01-01|title=The environment and susceptibility to schizophrenia|journal=Progress in Neurobiology|language=en|volume=93|issue=1|pages=23–58|doi=10.1016/j.pneurobio.2010.09.003|issn=0301-0082|last1=Brown|first1=Alan S.|pmid=20955757|pmc=3521525}} Severity or frequency of prenatal infections may also contribute to earlier onset of symptoms by means of congenital brain malformations, reduction or impairment of cognitive function, and psychological disorders.{{cite journal|vauthors=Nicolson R, Rapoport JL|date=November 1999|title=Childhood-onset schizophrenia: rare but worth studying|journal=Biological Psychiatry|publisher=Elsevier BV|volume=46|issue=10|pages=1418–28|doi=10.1016/s0006-3223(99)00231-0|pmid=10578456|s2cid=45154449}} It is believed that prenatal exposure to rubella modifies the developmental course during childhood, increasing the risk for childhood schizophrenia. Genetic predisposition is an important factor as well; familial mental illness is more frequently reported for childhood-onset schizophrenic patients.{{cite journal | vauthors = Kallmann FJ, Roth B | title = Genetic aspects of preadolescent schizophrenia | journal = The American Journal of Psychiatry | volume = 112 | issue = 8 | pages = 599–606 | date = February 1956 | pmid = 13292546 | doi = 10.1176/ajp.112.8.599 | publisher = American Psychiatric Publishing }} While it is hard to detect, there are relatives who are more-likely to be diagnosed with schizophrenia if they are children of individuals who have this disorder. "First degree relatives" are found to have the highest chance of being diagnosed with schizophrenia. Children of individuals with schizophrenia have a 8.2% chance of having schizophrenia while the general population is at an 0.86% chance of having this disorder.{{Cite journal |last1=Zahari |first1=Zalina |last2=Teh |first2=Lay Kek |last3=Ismail |first3=Rusli |last4=Razali |first4=Salleh Mohd |date=August 2011 |title=Influence of DRD2 polymorphisms on the clinical outcomes of patients with schizophrenia |url=http://dx.doi.org/10.1097/ypg.0b013e3283437250 |journal=Psychiatric Genetics |volume=21 |issue=4 |pages=183–189 |doi=10.1097/ypg.0b013e3283437250 |pmid=21206399 |s2cid=42218254 |issn=0955-8829}} These results indicate that genes play a big role in one developing schizophrenia.

There is "considerable overlap" in the genetics of childhood-onset and adult-onset schizophrenia, but in childhood-onset schizophrenia there is a higher number of "rare allelic variants".{{cite journal | vauthors = Asarnow RF, Forsyth JK | title = Genetics of childhood-onset schizophrenia | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 22 | issue = 4 | pages = 675–87 | date = October 2013 | pmid = 24012080 | pmc = 4364758 | doi = 10.1016/j.chc.2013.06.004 }} There have been several genes indicated in children diagnosed with schizophrenia that include: neuregulin, dysbindin, D-amino acid oxidase, proline dehydrogenase, catechol-Omethyltransferase, and regulator of G protein signaling. There have also been findings of 5HT2A and dopamine D3 receptor. An important gene for adolescent-onset schizophrenia is the catechol-O-methyltransferase gene, a gene that regulates dopamine.{{cite journal | vauthors = Godar SC, Bortolato M | title = Gene-sex interactions in schizophrenia: focus on dopamine neurotransmission | journal = Frontiers in Behavioral Neuroscience | volume = 8 | pages = 71 | year = 2014 | pmid = 24639636 | pmc = 3944784 | doi = 10.3389/fnbeh.2014.00071 | doi-access = free }} Children with schizophrenia have an increase in genetic deletions or duplication mutations{{Cite journal|last1=Squarcione|first1=Chiaras|last2=Torti|first2=Maria Chiara|last3=Fabio|first3=Fabio Di|last4=Biondi|first4=Massimo|date=2013-12-04|title=22q11 deletion syndrome: a review of the neuropsychiatric features and their neurobiological basis|journal=Neuropsychiatric Disease and Treatment|volume=9|pages=1873–1884|language=English|doi=10.2147/ndt.s52188|pmc=3862513|pmid=24353423 |doi-access=free }} and some have a specific mutation called 22q11 deletion syndrome, which accounts for up to 2% of cases.{{cite journal | vauthors = Squarcione C, Torti MC, Di Fabio F, Biondi M | title = 22q11 deletion syndrome: a review of the neuropsychiatric features and their neurobiological basis | journal = Neuropsychiatric Disease and Treatment | volume = 9 | pages = 1873–84 | year = 2013 | pmid = 24353423 | pmc = 3862513 | doi = 10.2147/NDT.S52188 | doi-access = free }}{{cite journal | vauthors = Giusti-Rodríguez P, Sullivan PF | title = The genomics of schizophrenia: update and implications | journal = The Journal of Clinical Investigation | volume = 123 | issue = 11 | pages = 4557–63 | date = November 2013 | pmid = 24177465 | pmc = 3809776 | doi = 10.1172/JCI66031 }}

Neuroimaging studies have found differences between the medicated brains of individuals with schizophrenia, and the brains of those without, though research does not know the cause of the difference.{{cite journal | vauthors = Brent BK, Thermenos HW, Keshavan MS, Seidman LJ | title = Gray matter alterations in schizophrenia high-risk youth and early-onset schizophrenia: a review of structural MRI findings | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 22 | issue = 4 | pages = 689–714 | date = October 2013 | pmid = 24012081 | pmc = 3767930 | doi = 10.1016/j.chc.2013.06.003 }} In childhood-onset schizophrenia, there appears to be a more rapid loss of cerebral grey matter during adolescence.{{cite journal | vauthors = Shaw P, Gogtay N, Rapoport J | title = Childhood psychiatric disorders as anomalies in neurodevelopmental trajectories | journal = Human Brain Mapping | volume = 31 | issue = 6 | pages = 917–25 | date = June 2010 | pmid = 20496382 | pmc = 6870870 | doi = 10.1002/hbm.21028 | publisher = Wiley-Blackwell | s2cid = 18033463 }} Studies have reported that adverse childhood experiences (ACEs) are the most preventable cause of the development of psychiatric disorders such as schizophrenia. ACEs have the potential to impact on the structure and function of the brain; structural changes revealed have been related to stress. Findings also report that different areas of the brain are affected by different types of maltreatment.{{cite journal |vauthors=Teicher MH, Samson JA |title=Annual Research Review: Enduring neurobiological effects of childhood abuse and neglect. |journal=Journal of Child Psychology and Psychiatry, and Allied Disciplines |volume=57 |issue=3 |pages=241–66 |date=March 2016 |pmid=26831814 |doi=10.1111/jcpp.12507|pmc=4760853 }}

{{transcluded section|source=Diagnosis of schizophrenia}}

{{#section-h:Diagnosis of schizophrenia|Criteria}}

The same criteria are used to diagnose children and adults. Diagnosis is based on reports by parents or caretakers, teachers, school officials, and others close to the child.

A professional who believes a child has schizophrenia usually conducts a series of tests to rule out other causes of behavior, and pinpoint a diagnosis. Three different types of study are performed: physical, laboratory, and psychological. Physical exams usually cover the basic assessments, including but not limited to; height, weight, blood pressure, and checking all vital signs to make sure the child is healthy.{{cite web|url=http://www.mayoclinic.com/health/childhood-schizophrenia/DS00868/DSECTION=tests-and-diagnosis|title=Childhood schizophrenia: Tests and diagnosis|date=17 December 2010|publisher=Mayo Clinic}} Laboratory tests include electroencephalogram EEG screening and brain imaging scans. Blood tests are used to rule out alcohol or drug effects, and thyroid hormone levels are tested to rule out hyper- or hypothyroidism.{{medcn|date=April 2015}} A psychologist or psychiatrist talks to a child about their thoughts, feelings, and behavior patterns. They also inquire about the severity of the symptoms, and the effects they have on the child's daily life. They may also discuss thoughts of suicide or self-harm in these one-on-one sessions. Some symptoms that may be looked at are early language delays, early motor development delays, and school problems.

Many people with childhood schizophrenia are initially misdiagnosed as having pervasive developmental disorders (autism spectrum disorder, for example).

Childhood schizophrenia manifests before the age of 13 and is also known as very early-onset schizophrenia. Onset before the age of 18 is known as early-onset schizophrenia, and is rare; very early-onset is even rarer with a frequency of 1 in 40,000.{{cite journal |last1=Hayes |first1=D |last2=Kyriakopoulos |first2=M |title=Dilemmas in the treatment of early-onset first-episode psychosis. |journal=Therapeutic Advances in Psychopharmacology |date=August 2018 |volume=8 |issue=8 |pages=231–239 |doi=10.1177/2045125318765725 |pmid=30065814|pmc=6058451 }}

The onset of childhood schizophrenia usually follows a period of normal, or near normal, development. Strange interests, unusual beliefs, and social impairment can be prodromal symptoms of childhood schizophrenia, but can also be signs of autism spectrum disorder. Hallucinations and delusions are typical for schizophrenia, but not features of autism spectrum disorder.{{cite book |author=American Psychiatric Association |title=Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) |chapter=Autism Spectrum Disorder. 299.00 (F84.0). Differential Diagnosis |year=2013 |pages=58 |location=Arlington, VA |publisher=American Psychiatric Publishing |isbn=978-0-89042-559-6 |doi=10.1176/appi.books.9780890425596 |hdl=2027.42/138395 }} In children hallucinations must be separated from typical childhood fantasies. Since childhood disintegrative disorder (CDD) has a very similar set of symptoms and high comorbidity it can be misdiagnosed as childhood schizophrenia, which can lead to prescribing ineffective medications.{{Cite journal|last1=Sawant|first1=Neena Sanjiv|last2=Parkar|first2=Shubhangi|last3=Kulkarni|first3=Prathamesh|date=2014-08-30|title=Childhood disintegrative disorder misdiagnosed as childhood-onset schizophrenia|url=http://sajp.org.za/index.php/sajp/article/view/518|journal=South African Journal of Psychiatry|volume=20|issue=3|pages=2|doi=10.4102/sajpsychiatry.v20i3.518|issn=2078-6786|doi-access=free}}

Childhood schizophrenia can be difficult to diagnosis simply because of how many disorders mimic the symptoms of CS. Though it can be difficult, that is why it is important to examine the whole mental state of the child at that time. Accurate and timely diagnosis is crucial, as misdiagnosis can adversely affect long-term treatment outcomes and prognosis.{{Cite journal |last1=Adhikari |first1=Samicchya |last2=Ghane |first2=Nejla |last3=Ascencio |first3=Marisa |last4=Abrego |first4=Tiffany |last5=Aedma |first5=Kapil |date=2022-02-25 |title=Differentiating Childhood-Onset Schizophrenia From Other Childhood Disorders |journal=Cureus |volume=14 |issue=2 |pages=e22594 |language=en |doi=10.7759/cureus.22594 |doi-access=free |issn=2168-8184 |pmc=8958114 |pmid=35371826}} Individuals who experience disorders such as major depressive disorder, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, delusional disorder and schizotypal personality disorder have all been known to exhibit similar symptoms to children who have been diagnosed with CS.{{Cite journal |last=Bartlett |first=Jennifer |date=2014-01-01 |title=Childhood-onset schizophrenia: what do we really know? |journal=Health Psychology and Behavioral Medicine |volume=2 |issue=1 |pages=735–747 |doi=10.1080/21642850.2014.927738 |issn=2164-2850 |pmc=4345999 |pmid=25750815}}

The three most common disorders that are difficult to distinguish are bipolar disorder (BD), autism spectrum disorder (ASD), and attention deficit hyperactive disorder (ADHD). BD, ASD, and ADHD overlap with symptom patterns in CS but a few distinguishing factors helps differentiate the disorders. Understanding these differences is crucial to diagnosing the child.

Individuals with bipolar disorder and childhood schizophrenia can both present psychotic symptoms such as hallucinations, delusions, and disorganized behaviors. A distinguishing feature in childhood schizophrenia, the hallucination, aren't taking place during a 'depressive or manic' episode as it would for an individual diagnosed with bipolar disorder. An individual with bipolar disorder has both low and high moods while one with CS, exhibits elements of depression.

Autism spectrum disorder share many features that are present in CS such as disorganized speech, social deficits, and extremely bizarre and repetitive behaviors. A hallmark of CS and distinguishing factor is when hallucinations last longer than one month. Should this occur, further examinations are necessary to determine if the child has ASD or CS.

Unlike the previous two disorders, ADHD and CS have fewer commonalities. Both individuals who have been diagnosed with CS and ADHD may appear to exhibit a poor attention span and disorganization. "Psychotic episodes are absent in ADHD, a distinct difference from CS".

It is important to understand that children diagnosed with childhood schizophrenia have higher rates of comorbidity, so exploring all resources is necessary to properly diagnose the child.

{{further|Early intervention in psychosis}}

Research efforts are focusing on prevention in identifying early signs from relatives with associated disorders similar to schizophrenia and those with prenatal and birth complications. Prevention has been an ongoing challenge because early signs of the disorder are similar to those of other disorders. Also, some of the schizophrenic-related symptoms are often found in children without schizophrenia or any other diagnosable disorder.

Current methods in treating early-onset schizophrenia follow a similar approach to the treatment of adult schizophrenia. Although methods of treatment for childhood schizophrenia are largely understudied, the use of antipsychotic medicine is normally the primary line of treatment in addressing signs in childhood schizophrenia diagnoses. Contemporary practices of schizophrenia treatment are multidisciplinary, recuperation oriented, and consist of medications, with psychosocial interventions that include familial support systems.{{Cite journal|last=Chan|first=Vivien|date=April 26, 2017|title=Schizophrenia and Psychosis|journal=Child and Adolescent Psychiatric Clinics of North America|language=en|volume=26|issue=2|pages=341–366|doi=10.1016/j.chc.2016.12.014|pmid=28314460|doi-access=free}} However, research has shown that atypical antipsychotics may be preferable because they cause less short-term side effects.{{Cite journal|last1=Kumar|first1=Ajit|last2=Datta|first2=Soumitra S|last3=Wright|first3=Stephen D|last4=Furtado|first4=Vivek A|last5=Russell|first5=Paul S|date=2013-10-15|title=Atypical antipsychotics for psychosis in adolescents|url=http://dx.doi.org/10.1002/14651858.cd009582.pub2|journal=Cochrane Database of Systematic Reviews|issue=10|pages=CD009582|doi=10.1002/14651858.cd009582.pub2|pmid=24129841|issn=1465-1858|pmc=11339588}} When weighing treatment options, it is necessary to consider the adverse effects, such as metabolic syndrome,{{Cite journal|last1=DE HERT|first1=MARC|last2=SCHREURS|first2=VINCENT|last3=VANCAMPFORT|first3=DAVY|last4=VAN WINKEL|first4=RUUD|date=February 2009|title=Metabolic syndrome in people with schizophrenia: a review|journal=World Psychiatry|volume=8|issue=1|pages=15–22|doi=10.1002/j.2051-5545.2009.tb00199.x|issn=1723-8617|pmc=2656262|pmid=19293950}} of various medications used to treat schizophrenia and the potential implications of these effects on development.{{cite journal | vauthors = Cohen D, Bonnot O, Bodeau N, Consoli A, Laurent C | title = Adverse effects of second-generation antipsychotics in children and adolescents: a Bayesian meta-analysis | journal = Journal of Clinical Psychopharmacology | volume = 32 | issue = 3 | pages = 309–16 | date = June 2012 | pmid = 22544019 | doi = 10.1097/JCP.0b013e3182549259 | s2cid = 5920580 }} A 2013 systematic review compared the efficacy of atypical antipsychotics versus typical antipsychotics for adolescents:

|}

Madaan et al. wrote that studies report efficacy of typical neuroleptics such as thioridazine, thiothixene, loxapine and haloperidol, high incidence of side effects such as extrapyramidal symptoms, akathisia, dystonias, sedation, elevated prolactin, tardive dyskinesia.

A very-early diagnosis of schizophrenia leads to a worse prognosis than other psychotic disorders.{{cite journal | vauthors = Clemmensen L, Vernal DL, Steinhausen HC | title = A systematic review of the long-term outcome of early onset schizophrenia | journal = BMC Psychiatry | volume = 12 | pages = 150 | date = September 2012 | pmid = 22992395 | pmc = 3521197 | doi = 10.1186/1471-244X-12-150 | doi-access = free }} The primary area that children with schizophrenia must adapt to is their social surroundings. It has been found, however, that very early-onset schizophrenia carried a more severe prognosis than later-onset schizophrenia. Regardless of treatment, children diagnosed with schizophrenia at an early age have diminished social skills, such as educational and vocational abilities.{{Cite journal|last=Bartlett|first=Jennifer|date=January 1, 2014|title=Childhood-onset schizophrenia: what do we really know?|journal=Health Psychology and Behavioral Medicine|language=en|volume=2|issue=1|pages=735–747|doi=10.1080/21642850.2014.927738|issn=2164-2850|pmc=4345999|pmid=25750815}}

File:Schizophrenia brain large.gif

The grey matter in the cerebral cortex of the brain shrinks over time in people with schizophrenia; the question of whether antipsychotic medication exacerbates or causes this has been controversial. A 2015 meta-analysis found that there is a positive correlation between the cumulative amount of first generation antipsychotics taken by people with schizophrenia and the amount of grey matter loss, and a negative correlation with the cumulative amount of second-generation antipsychotics taken.{{cite journal | vauthors = Vita A, De Peri L, Deste G, Barlati S, Sacchetti E | title = The Effect of Antipsychotic Treatment on Cortical Gray Matter Changes in Schizophrenia: Does the Class Matter? A Meta-analysis and Meta-regression of Longitudinal Magnetic Resonance Imaging Studies | journal = Biological Psychiatry | volume = 78 | issue = 6 | pages = 403–12 | date = September 2015 | pmid = 25802081 | doi = 10.1016/j.biopsych.2015.02.008 | hdl = 11379/458510 | s2cid = 27008041 | hdl-access = free }}{{cite journal | vauthors = Navari S, Dazzan P | title = Do antipsychotic drugs affect brain structure? A systematic and critical review of MRI findings | journal = Psychological Medicine | volume = 39 | issue = 11 | pages = 1763–77 | date = November 2009 | pmid = 19338710 | doi = 10.1017/S0033291709005315 | s2cid = 4919922 }}

Schizophrenia disorders in children are rare. Boys are twice as likely to be diagnosed with childhood schizophrenia.{{cite journal| vauthors = Gonthier M, Lyon MA |title=Childhood-Onset Schizophrenia: An Overview|journal=Psychology in the Schools|date=22 July 2004|volume=41|issue=7|pages=803–811|doi=10.1002/pits.20013}} There is often a disproportionately large number of males with childhood schizophrenia, because the age of onset of the disorder is earlier in males than females by about 5 years. Clinicians have been and still are reluctant to diagnose schizophrenia early on, primarily due to the stigma attached to it.{{cite book | first1 = Rita | last1 = Wicks-Nelson | first2 = Allen C | last2 = Israel |isbn=978-0-13-235978-8 |year=2009|chapter=Pervasive developmental disorders and schizophrenia| veditors = Jewell L |title=Abnormal child and adolescent psychology|pages=327–359|location=Upper Saddle River, NJ|publisher=Prentice Hall Higher Education}}

While very early-onset schizophrenia is a rare event, with prevalence of about 1:40,000, early-onset schizophrenia manifests more often, with an estimated prevalence of 0.5%.{{cite journal | vauthors = Madaan V, Dvir Y, Wilson DR | title = Child and adolescent schizophrenia: pharmacological approaches | journal = Expert Opinion on Pharmacotherapy | volume = 9 | issue = 12 | pages = 2053–68 | date = August 2008 | pmid = 18671461 | doi = 10.1517/14656566.9.12.2053 | publisher = Informa Healthcare | s2cid = 71397213 }}

Until the late nineteenth century, children were often diagnosed with psychosis like schizophrenia, but instead were said to have "pubescent" or "developmental" insanity. Through the 1950s, childhood psychosis began to become more and more common, and psychiatrists began to take a deeper look into the issue.{{Failed verification|date=September 2018}}

Sante De Sanctis first wrote about child psychoses, in 1905. He called the condition "dementia praecocissima" (Latin, "very premature madness"), by analogy to the term then used for schizophrenia, "dementia praecox" (Latin, "premature madness).{{cite book|author=Richard Noll|title=The Encyclopedia of Schizophrenia and Other Psychotic Disorders|url=https://books.google.com/books?id=jzoJxps189IC&pg=PA131|year=2009|publisher=Infobase Publishing|isbn=978-0-8160-7508-9|pages=131}} De Sanctis characterized the condition by the presence of catatonia.{{cite book|author=Robert Jean Campbell|title=Campbell's Psychiatric Dictionary|url=https://books.google.com/books?id=76vPu_G2UkgC&pg=PA265|year=2009|publisher=Oxford University Press|isbn=978-0-19-534159-1|pages=265–266}} Philip Bromberg thinks that "dementia praecocissima" is in some cases indistinguishable from childhood schizophrenia; Leo Kanner believed that "dementia praecocissima" encompassed a number of pathological conditions.

Theodor Heller discovered a new syndrome dementia infantilis (Latin, "infantile madness") in 1909 which was named Heller syndrome.{{cite book|author=Dirk Marcel Dhossche|title=Catatonia in Autism Spectrum Disorders|url=https://books.google.com/books?id=v9FvvOxzZAwC&pg=PA5|year=2006|publisher=Elsevier|isbn=978-0-08-046338-4|pages=4–5}} In ICD-11 Heller syndrome is classed as an autism spectrum subtype.{{cite web |title=ICD-11 - Mortality and Morbidity Statistics |url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1477082111 |website=icd.who.int |access-date=27 November 2020}}

In 1909, Julius Raecke reported on ten cases of catatonia in children at the Psychiatric and Neurological Hospital of Kiel University, where he worked. He described symptoms similar to those previously recorded by Dr. Karl Ludwig Kahlbaum, including "stereotypies and bizarre urges, impulsive motor eruptions and blind apathy." He also reported refusal to eat, stupor with mutism, uncleanliness, indications of waxy flexibility and unmotivated eccentricity, and childish behavior.

A 1913 paper by Karl Pönitz, "Contribution to the Recognition of Early Catatonia",{{cite book |last1=Leonhard |first1=Karl | name-list-style = vanc |title=Classification of Endogeneous Psychoses and their Differentiated Etiology |date=1995 |publisher=Springer Science & Business Media |isbn=3-211-83259-9 |page=335 |edition=2nd |url=https://books.google.com/books?id=OWorBgAAQBAJ&q=karl+ponitz+early+catatonia&pg=PA335 |access-date=25 September 2018}} recounts a case study of a boy who manifested "typical catatonia" from the age of twelve, characterizing him as showing a "clear picture of schizophrenia."

Before 1980 the literature on "childhood schizophrenia" often described a "heterogeneous mixture" of different disorders, such as autism, "symbiotic psychosis" or psychotic disorder other than schizophrenia, pervasive developmental disorders and dementia infantilis.{{cn|date=January 2025}}

{{Reflist}}

• {{cite journal | vauthors = Tiffin PA, Welsh P | title = Practitioner review: schizophrenia spectrum disorders and the at-risk mental state for psychosis in children and adolescents--evidence-based management approaches | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 54 | issue = 11 | pages = 1155–75 | date = November 2013 | pmid = 24102356 | doi = 10.1111/jcpp.12136 }}

{{Mental and behavioral disorders}}

{{DEFAULTSORT:Pediatric Schizophrenia}}

Category:Schizophrenia

Category:Mental disorders diagnosed in childhood

Category:Bloody Mary (folklore)

de:Schizophrenie#Schizophrenie bei Kindern