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Childhood Schizophrenia CHILDHOOD SCHIZOPHRENIA Definitions Paranoid ideation differs from paranoid delusions (2 CE HOURS) Schizophrenia is thought to be the most in that the ideas are held with less conviction common form of child, adolescent, and adult than with the patient who is delusional. Learning objectives psychosis. Symptoms often include delusions, Extrapyramidal side effects (EPS) are the ! To understand the history of childhood thought disorders, as well as auditory, visual, and various movement disorders such as tardive schizophrenia and psychosis. other types of hallucinations, and paranoia. dyskinesia suffered as a result of taking ! To understand the significant definitions Delusions are unshakable beliefs that hold no dopamine antagonists, usually antipsychotic related to childhood schizophrenia and or little basis in reality. For example, people (neuroleptic) drugs, which are often used to psychosis including (but not limited to): with psychosis might strongly believe that control psychosis, especially schizophrenia. schizophrenia, delusions, hallucinations, and the government is plotting to harm them, that The best known EPS is tardive dyskinesia thought disorders. they are being spied on through the radio or (involuntary, irregular muscle movements, ! To understand the components of screening television, that they have special “super” power; usually in the face). Other common EPS include: and diagnosis for childhood schizophrenia or that evil forces are trying to kill them. ■ Akathisia (often observed as the inability and psychosis. A thought disorder is when a person’s thinking to remain seated due to motor restlessness ! To understand the diagnostic criteria for is confused. A person with a thought disorder or due to a sensation of muscular quivering. childhood schizophrenia and psychosis. may be hard to understand. Their ideas will often It is a side effect of many neuroleptic ! To understand the differences in symptoms be disorganized, but it is more than just ordinary medications). between children/adolescents and adults. confusion. ■ Dystonia (muscular spasms of neck). ! To understand the prevention of childhood ■ Oculogyric crisis, (muscular spasms of schizophrenia and psychosis. Hallucinations are when someone sees, hears, tongue, or jaw; more frequent in children). ! To understand the inherent difficulties smells, or feels something that does not really ■ Drug-induced parkinsonism – which in treating childhood schizophrenia and exist. The most common form of hallucination includes (muscle stiffness, shuffling gait, psychosis. is auditory in nature. Persons with auditory drooling, tremor; less frequent in children ! To understand the outcomes related to hallucinations often report hearing voices. In and adolescents, more frequently observed in childhood schizophrenia and psychosis. some cases those voices will tell a person to do adults and the elderly). ! To understand the current research into a specific act. This type of auditory hallucination childhood schizophrenia and psychosis. is called a command auditory hallucination. A dopamine antagonist is a drug which blocks The person with schizophrenia who experiences dopamine receptors. Introduction hallucinations will often believe that the Positive symptoms are abnormal thoughts The existence of childhood psychoses has hallucinations are totally real. Patients with and perceptions such as disordered thinking, been noted, discussed, and at times dismissed hallucinations may act strangely. For example, delusions, and hallucinations. for over one hundred years. In 1867 Henry they may talk or laugh to themselves as if Maudsley, a British psychiatrist, wrote in his conversing with somebody that the clinician Negative symptoms are loss, or decrease, of textbook, Physiology and Pathology of Mind, a can’t see. When the client responds to the normal functions often evidenced by blunted work entitled “Insanity of Early Life.” Kanner hallucinations it is said they are responding to affect, impaired attention, avolition, and later noted that Maudsley was dismissed by his internal stimuli. anhedonia. contemporaries for acknowledging the existence The second most common hallucination is visual Avolition is a psychological state characterized of “insanity” in childhood. Much of the early in nature. The person who experiences visual by general lack of desire, motivation, and literature regarding childhood psychosis reveals hallucinations may see people who don’t exist persistence. Avolition is commonly seen in conflicting points of view, definitions, and or, in some cases, may see relatives, long dead patients with schizophrenia. Persons suffering classifications that kept changing over time. and buried. Children with visual hallucinations from avolition may not start or complete any Today, childhood schizophrenia and psychosis may report seeing mythological creatures such major tasks. are well established disorders (Tengan and Maia, as monsters and dragons. In rare cases, patients Anhedonia is the inability to experience 2004).Childhood schizophrenia is a severe and with psychosis may experience olfactory or most often persistent mental disorder that is pleasure from normally pleasurable life events tactile hallucinations, although these are seldom such as eating, exercise, playing and other forms characterized by a loss of contact with reality, observed in children. changes in personality, and moderate to severe of social interaction. difficulty with social functioning. Tolbert (1996) Psychosis is a thought disorder where the Blocking is the disruption of thought evidenced provides an inventory of symptoms frequently person is unable to distinguish reality from by an interruption or momentary disruption of seen in children with psychosis: fantasy because of impaired reality testing. The speech. The individual appears to be trying to ■ Auditory hallucinations. boundary between non-psychotic and psychotic remember what he or she was thinking or saying. ■ Confused thinking. ideation and perception is not clearly delineated Loosening of associations is a disorder of ■ Confusion of television with reality. in the literature. thinking and speech in which ideas shift from ■ Diminished interest. Paranoia is often characterized by delusions one subject to another with remote or no ■ Disinheriting. involving: apparent reasons. ■ Extreme moodiness. ■ Guardedness. ■ Ideas that others are ‘out to get them’. ■ Hyperalertness. Stereotypy is a behavioral condition ■ Inability to distinguish dreams from reality. ■ Hypersensitivity. characterized by a lack of variation in patterns of ■ Odd and/or eccentric behavior. ■ Jealousy. thought, motion and speech; by repetition of said ■ Severe problems making and keeping ■ Persecution. patterns; or both. friends. ■ Suspiciousness. ■ Speech disturbances. Screening and diagnosis Paranoid ideation evidences itself as patients ■ Stereotypy. Screening ■ Visual hallucination. being convinced that other people are: A complete screening and diagnostic workup for ■ Vivid and bizarre thoughts and ideas. ■ Thinking “bad thoughts” about them. ■ That they are being followed. childhood schizophrenia will include some or all ■ That they are the object of any number of of the following: dark conspiracies. ■ A complete history including: Elite Page 1 □ Medical. attenuated form (e.g., odd beliefs, unusual disruptive behavior disorders. Hearing a voice □ Social. perceptual experiences). suggesting suicide was most often associated □ Family history. ■ Schizoaffective and mood disorder with depression. The clinician must strive ■ Interviews with child, parents, guardians, exclusion: Schizoaffective Disorder and to understand the context and content of the and other caregivers to assess possible Mood Disorder With Psychotic Features hallucinations when diagnosing a young child. psychotic symptoms, changes in behavior have been ruled out because either (1) As stated above, in childhood, and most and the possibility of other psychiatric no Major Depressive, Manic, or Mixed especially during adolescence, the affective problems. Episodes have occurred concurrently with symptoms of schizophrenia can sometimes ■ Tests to assess cognitive skills and functional the active-phase symptoms; or (2) if mood be mistaken for age appropriate moodiness or abilities in daily life. episodes have occurred during active-phase oppositional behavior. It is worth noting that ■ A review of school records and/or other input symptoms, their total duration has been brief in children and adolescents, hearing voices is from school personnel. relative to the duration of the active and not always a sign of schizophrenia, but may be ■ Various lab tests may be indicated: residual periods. due in part to anxiety, stress, depression, family □ Toxicology screens may be needed if ■ Substance/general medical condition dynamics, or cultural issues. substance abuse is suggested. exclusion: The disturbance is not due to the □ Liver function studies, copper, and direct physiological effects of a substance Differences in symptoms between ceruloplasmin are part of the workup for (e.g., a drug of abuse, a medication) or a children/adolescents and adults Wilson disease. general medical condition. All three major classificatory/diagnostic systems □ Obtain porphobilinogen for porphyria. ■ Relationship to a pervasive developmental (ICD-9, ICD-10 and DSM-IV-TR) have no □ HIV titers may be needed. disorder: If there is a history of special criteria for children and recommend the □ Brain-imaging tests such as MRI or Autistic
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