Patients with childhood schizophrenia exhibit similar clinical symptoms as adults with the disorder, but they are less prone to elaborate delusions or visual hallucinations. Some important features can differentiate the two different types of schizophrenia. These include a more extensive family history of the disease, an insidious onset, more prominent deterioration of cognitive functioning, symptoms that are in general more severe, presence of various genetic and developmental abnormalities including motor disability as well as mental dysfunction, and organic cerebral changes such as increases in the volume of the ventricles and loss of cortical gray matter.

Schizophrenia is diagnosed by identifying a collection of symptoms. No single symptom is uniquely associated with the disease. First rank symptoms that were described in 1959 by Kurt Schneider are considered important in the establishment of the diagnosis. They include hallucinations, delusions, thought insertion or withdrawal and auditory hallucinations characterized by a running commentary over the behavior of the patient.

Furthermore, hallucinations characteristic of the disorder are somatic in nature. They tend to refer to various sensations in many body organs but with no attributable organic cause. Delusions usually manifest in beliefs that an external authority has the capacity to insert or remove particular thoughts from the mind of the patient.

Symptoms in schizophrenia can be further classified into positive or negative. Positive symptoms generally refer to behavior that is an excess of what is generally considered normal. These include the first rank symptoms defined by Schneider, in addition to disorganized thought, speech and behavior. Speech abnormalities are a hallmark of the disease, and they principally manifest with looseness of association, in which the patient falsely creates relationships between unrelated semantic concepts. Tangentiality is another feature of the disease, and it describes a patient's tendency to stray off from a present topic into a completely different one without any logical coherence. Patients may also talk in a "word salad", whereby the speech has almost a complete lack of logical and semantic coherence. In addition to thought and speech processes, behavior can also be disorganized in the sense that the patient is unable to accomplish goal-oriented tasks such as the preparation of meals or taking care of their daily needs. Patients may also exhibit increased agitation in the form of cursing or loud shouting, dress inadequately or perform sexual acts in public.

Negative symptoms, on the other hand, represent an absence of behavior that is expected to be common in normal individuals. Several negative symptoms are critical in the establishment of the diagnosis and are generally associated with greater social and emotional dysfunction. A deficiency in processing and exhibiting emotions is termed affective flattening and is very characteristic of the disease. In addition, patients may display poor speech content and show a complete absence of motivation to perform tasks. Negative symptoms are usually harder to identify for psychiatrists than positive ones.

• Malnutrition

  […] developing or triggering schizophrenia, including: Having a family history of schizophrenia Increased immune system activation, such as from inflammation or autoimmune diseases Older age of the father Some pregnancy and birth complications, such as malnutrition [mayoclinic.com]

  Risk factors • Family history of schizophrenia • Exposure to viruses, toxins or malnutrition while in the womb • Abnormal activation of the immune system • Older age of the father • Taking psychoactive drugs during teen years 6. [slideshare.net]

  Prenatal factors that are likely to contribute include infections in the second trimester with influenza, blood type incompatibility between mother and fetus that went untreated, malnutrition and deficiency in oxygen at birth. [symptoma.com]

• Pain

  For example, language delays, flat affect, decreased emotional expression, lack of interest in interpersonal relationships or social situations, delayed reaction to pain or decreased sensitivity to pain, abnormal motor movements such as rocking back and [blogs.psychcentral.com]

  This was a very painful time for the staff as well and we didn't know how to help him stay alive. [maps.org]

  EPSs include parkinsonism, in which the patient cannot walk normally and usually develops a tremor; dystonia, or painful muscle spasms of the head, tongue, or neck; and akathisia, or restlessness. [medical-dictionary.thefreedictionary.com]

  […] evil force, spirit or entity has “possessed” the body or mind lapses in personal hygiene practices long periods of staring without blinking or difficulty focusing on objects rapidly fluctuating moods seeing or hearing things that others do not sudden, painful [childrenshospital.org]

• Movement Disorder

  Side effects may include tremors, slowed movements, movement disorders, and metabolic syndrome (which includes obesity, type 2 diabetes, and abnormal levels of fat in the blood). [merckmanuals.com]

  Fourth, the diagnosis of neuroleptic malignant syndrome, which some consider a form of malignant catatonia, is listed separately as a medication-induced movement disorder (code 333.92). [doi.org]

  These can include the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be reversible. [drugs.com]

  Serious side effects may include weight gain, diabetes, high cholesterol and movement disorders (Mayo Clinic (b), 2010). Antipsychotics are often not recommended for pediatric use due the intensity of such side effects. [neurosciencefundamentals.unsw.wikispaces.net]

• Epilepsy

  The researchers combed through 25 large studies of autism, adult-onset schizophrenia, intellectual disability and epilepsy to select 48 large, rare CNVs associated with those disorders. [sfari.org]

  Covers diverse topics such as “The Bipolar Child”, “Epilepsy”, “Psychosis”, “Cell Phones”, “Menopause and the Mind” and many many more. [schizophrenia.com]

  The schizophrenia-like psychoses of epilepsy. British Journal of Psychiatry, 1963, 109, 95–150. PubMed Google Scholar Tarjan, M. D., Tizard, J., Rutter, M., Begab, M., Brooke, E. M., De La Cruz, F., Lin, T. [link.springer.com]

  Thought disorder: A developmental disability in pediatric epilepsy. Epilepsy Behav. 2006 Jun. 8(4):726-35. [Medline]. Bourgou S, Halayem S, Amado I, Triki R, Bourdel MC, Franck N, et al. [emedicine.medscape.com]

  These conditions include organic brain disorders (including traumatic injuries of the brain), temporal lobe epilepsy, Wilson's disease, prion diseases, Huntington's chorea, and encephalitis. [medical-dictionary.thefreedictionary.com]

• Anorexia

  Anorexia Nervosa in Children. Filipino Ang Anorexia Nervosa sa mga Bata at Kabataan 868 Healthy Kids. Anxiety in Children. Filipino Matinding Pagkabalisa (Anxiety) sa mga bata 703 Healthy Kids. Complete. Filipino Healthy Kids. Complete. [dhi.health.nsw.gov.au]

  […] attention deficit disorder with hyperactivity / impulsivity - Mental retardation - Autism and Asperger's Syndrome - Learning disabilities - The Anxiety Disorders - The Depressive disorders - The Obsessive Compulsive Disorder - Childhood Schizophrenia - Anorexia [unich.it]

  Structural Neuroimaging of Anorexia Nervosa: Future Directions in the Quest for Mechanisms Underlying Dynamic Alterations. Biological Psychiatry, Vol. 83, Issue. 3, p. 224. CrossRef Google Scholar Hashimoto, Naoki Ito, Yoichi M. [doi.org]

• Bulimia Nervosa

  View Article PubMed Google Scholar Steinhausen HC, Weber S: The outcome of bulimia nervosa: findings from one-quarter century of research. Am J Psychiatry. 2009, 166: 1331-1341. [doi.org]

• Osteoporosis

  Problems with case study research panicking dissertation, database schema case study how do you assess critical thinking skills osteoporosis case study example, argumentative essay on abortions can an essay have 1 body paragraphs disadvantages of modern [clubdevacaciones.mx]

• Delusion

  Signs and symptoms may include: Delusions. These are false beliefs that are not based in reality. [mayoclinic.com]

  In a research delusions were characterized as persecutory for the most part, but some children reported delusions of control. [en.wikipedia.org]

  Delusion — A fixed, false belief that is resistant to reason or factual disproof. [medical-dictionary.thefreedictionary.com]

  These help to control symptoms of hallucination, delusion, and disorganized thinking. [medicalnewstoday.com]

  But despite these difficulties, there are some kids who do seem to have persistent troubling delusions and hallucinations along similar lines to schizophrenia. [mindhacks.com]

• Suggestibility

  Genetic risk Several factors suggest a genetic risk. [emedicine.medscape.com]

  Reevaluation of the minimum age of onset for adult-type schizophrenia is suggested. [ncbi.nlm.nih.gov]

  The research further suggests a strong relationship between environment and the development of psychosis, and provides clues about the mechanisms leading to severe mental illness. [sciencedaily.com]

  Evidence suggests that the rate of genetically-linked abnormalities is twice as high in children as in adults with the illness. [schizophrenia.com]

• Fear

  Children may begin talking about odd fears or ideas. In children or adolescents there is a failure to achieve what is expected of the individual, rather than a deterioration in functioning. [schizophrenia.com]

  Children may begin talking about strange fears and ideas. They may start to cling to parents or say things that do not make sense. [psychotherapyclinicokc.com]

  Schools don’t know how to educate or manage these children, and other parents fear having them around their neurotypical sons and daughters. [namimass.org]

  He or she may start to talk about odd ideas or fears and start to cling more to parents. Each child’s symptoms may vary. [urmc.rochester.edu]

• Auditory Hallucination

  Among the actual psychotic symptoms seen in childhood schizophrenia auditory hallucinations are the most common. They are often presented in relatively simple form of akoasms (auditory hallucinations, such as noise, shots, knocks, etc.). [en.wikipedia.org]

  Children with schizophrenia often hear voices and other noises that other people do not hear (auditory hallucinations ). They also firmly believe something is true even when there is proof that it is false ( delusion ). [cigna.com]

• Visual Hallucination

  Among the 35 children in the UCLA study, 80 percent presented with auditory hallucinations, 74 percent with flat or inappropriate affect, 63 percent with delusions, 40 percent with formal thought disorder, and 37 percent with visual hallucinations. [academic.oup.com]

  Hallucinations – An obvious sign is if the child experiences auditory hallucinations (e.g. hearing voices in their head ) and/or experiences visual hallucinations (e.g. sees things that aren’t really there). [mentalhealthdaily.com]

  Patients with childhood schizophrenia exhibit similar clinical symptoms as adults with the disorder, but they are less prone to elaborate delusions or visual hallucinations. [symptoma.com]

  hallucinations of people and objects that are not actually there auditory hallucinations of voices, music or other sounds that are not real delusions of threats and other situations with no basis in reality severe difficulty making friends and maintaining [childrenshospital.org]

  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. [en.wikipedia.org]

• Irritability

  Irritability vs. Bipolar Spectrum Disorders Irritability is a symptom of pediatric Bipolar Spectrum Disorders, but it is also a symptom of many other childhood disorders and is sometimes shown by healthy children. [abnormalchildpsychology.org]

  Especially at first, symptoms may look like the stuff of typical teen years: bad grades, changing friends, trouble sleeping, or irritability. [webmd.com]

  Someone who is repeatedly depressed, crying often, unable to sleep or sleeping too much, eating too much or not eating enough, exhibit a in irritability for no apparent reason, picking fights, or simply hopeless, is usually in need of intervention. 5. [blogs.psychcentral.com]

• Catatonia

  […] and 1 on the treatment of catatonia. [doi.org]

  Catatonia is no longer so strongly associated with schizophrenia. [en.wikipedia.org]

  […] listing, your child’s medical records must show that he or she experiences at least one of the following: delusions or hallucinations disorganized thinking (such as illogical thoughts), revealed in the child's speech, or grossly disorganized behavior or catatonia [disabilitysecrets.com]

• Apathy

  Karl Ludwig Kahlbaum, including "stereotypies and bizarre urges, impulsive motor eruptions and blind apathy." [en.wikipedia.org]

  Apathy and confusion; delusions and hallucinations; rambling or stylized patterns of speech, such as evasiveness, incoherence, and echolalia; withdrawn, regressive, and bizarre behavior; and emotional lability often occur. [medical-dictionary.thefreedictionary.com]

• Insomnia

  Abnormal sleep habits Excessive sleep, insomnia, or other sleep disturbances can signal schizophrenia. [healthcentral.com]

  They may also abruptly withdraw from social interaction, develop insomnia, and suffer from depression and irritability. [webpsychology.com]

  […] because many teens exhibit many of the behaviors seen in youngsters who are diagnosed with schizophrenia such as: Withdrawing from friends and family Struggling with grades or experiencing a drop in GPA Irritability, aggression, and mood instability Insomnia [blogs.psychcentral.com]

  […] without blinking or difficulty focusing on objects rapidly fluctuating moods seeing or hearing things that others do not sudden, painful sensitivity to light and noise sudden, significant changes in sleep patterns—either inability to fall or stay asleep ( insomnia [childrenshospital.org]

• Excitement

  They may be unable to express excitement, joy, or any kind of happiness. [mentalhealthdaily.com]

  In some patients rigidity alternates with excited or hyperactive behavior. Delusion — A fixed, false belief that is resistant to reason or factual disproof. [medical-dictionary.thefreedictionary.com]

  She was excited about this new situation and did not have any relapses. Patty did not seem to experience fear of the new situation but was excited about the opportunity to be in new surroundings and she did very well. [maps.org]

  […] affective content, or by persistent over‐valued ideas, or when occurring every day for weeks or months on end; f) breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech, or neologisms; g) catatonic behaviour, such as excitement [doi.org]

Diagnosis of schizophrenia is established clinically although laboratory tests are usually administered to rule out other causes of the symptoms.

In cases where substance abuse is suspected, a urine toxicology screen may be necessary. Wilson disease can also sometimes present with severe psychotic episodes and is usually diagnosed with liver function tests and an assessment of copper and ceruloplasmin serum levels. Other necessary tests may include VDRL (Venereal Disease Research Laboratory) for syphilis, HIV (Human Immunodeficiency Virus) testing, porphobilinogen for porphyria and a screen for heavy metals. Some children may also exhibit mental retardation as well as abnormal physical features. In these cases, it is recommended to perform a genetic assessment and a karyotype that may reveal the 22q11 deletion syndrome or 5q chromosomal mutation [10].

Imaging with MRI or CT is usually routinely performed for patients with a first episode of psychosis. MRI is the preferred modality although CT is an acceptable substitute, in case MRI is not available. Imaging may show an enlargement of the ventricles, as well as losses in gray matter. These findings, however, are not sufficient to diagnose the disease. MRI may also identify other conditions that can manifest similarly to schizophrenia. Leukodystrophy is generally associated with demyelination and neuronal ceroid lipofuscinosis with atrophy.

Patients who exhibit symptoms in an episodic fashion may be investigated with electroencephalography (EEG). Furthermore, treatment with clozapine necessitates an EEG because of an elevated risk of seizure occurrences.

Pathological analyses are usually restricted on postmortem tissue, most frequently for research studies. They have shown decreased hippocampal volume, although no gliosis has been identified. The presence of gliosis generally indicates the presence of an ongoing inflammatory process. Most pathological analyses have been performed on tissue from adult onset schizophrenia.

The mental status examination is the most important tool in the armory of the psychiatrist to diagnose schizophrenia. It generally follows a structured or a semi-structured form, especially during the first assessment. It should be also utilized to monitor symptoms of the patients during later visits. Standardized psychological approaches have been devised to assess particular elements of the disease. These include the brief psychiatric rating scale (BPRS), the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) and the Positive and Negative Syndrome Scale (PANSS) [11]. More symptoms can sometimes be detected with the help of the Rorschach test and the Thematic Apperception Test. Extensive psychological tests are sometimes necessary when devising adequate treatment plans.

Treatment of childhood schizophrenia consists mainly of pharmacotherapy and psychosocial management. The mainstay of medical treatment is with antipsychotics. The initial drugs that are employed are the atypical neuroleptics. Benzodiazepines are sometimes used to calm an agitated child and decrease anxiety. Agitation and anxiety can be particularly prominent in psychosis.

Children with schizophrenia open link may also undergo training in social skills. Supportive and cognitive behavioral therapy can also be used to improve coping strategies and help the child identify coming relapses.

Childhood schizophrenia is generally characterized by a worse prognosis than schizophrenia with an onset in adulthood. Children with the disorder eventually become less independent in adulthood are less likely to be employed and have fewer academic achievements and social relationships. Patients who develop schizophrenia generally fare worse than those with a more acute onset. They are also less likely to respond to medication.

Patients with schizophrenia have a more elevated risk of committing suicide. Studies indicate that suicide risk is 5 to 11% in patients with childhood schizophrenia. Around 50% will have significant social impairment, manifested in both academic and occupational status. 10% of all adults with schizophrenia will commit suicide.

Adolescents affected by schizophrenia are also likely to display violent behavior, as well as impulsivity that could result in injury, substance dependence and abuse and the acquirement of sexually transmitted diseases.

The etiological factors underlying schizophrenia remain unknown but both genetic and environmental factors are thought to be involved. In particular, genetic predispositions, prenatal factors and future stressful occurrences are thought to ultimately result in neurodevelopmental abnormalities leading to the disease. Genetic involvement has long been suspected as can be evidenced by an increase in the risk of having the disease when it is present in first-degree relatives or identical twin siblings. Indeed, risk increases from 1 to 10% in first-degree relatives and to 50% in case of an identical twin of a patient with the disease. Prenatal factors that are likely to contribute include infections in the second trimester with influenza, blood type incompatibility between mother and fetus that went untreated, malnutrition and deficiency in oxygen at birth.

Genes that were associated with childhood schizophrenia have been also linked to a wide range of diseases including Alzheimer's disease, Crohn disease and breast cancer [4]. Children with schizophrenia also tend to have more frequent genetic abnormalities than adults with schizophrenia. In addition, the disease is associated with a genetic predisposition for schizophrenia in close family members. One study found that up to a third of families of children with schizophrenia have first-degree relatives with paranoid personality disorder, schizotypal personality disorder or schizophrenia. These rates are extremely close to what is generally observed in the adult form of the disease, indicating that both forms may have similar underlying etiology [5]. Families of children with schizophrenia tend to also have more common abnormalities in eye movements.

Childhood schizophrenia is a very rare disease with prevalence estimated at around 1 case in every 10,000 individuals in the United States. Prevalence increases remarkably with late onset, and approaches 1% for the form of the condition that starts in late adolescence or early childhood.

Prevalence of schizophrenia is almost uniform internationally, with slight increases in more urban environments. Nonetheless, rates in underdeveloped countries are still unknown. Schizophrenia is also more common in men relative to women with an approximate ratio of 2:1.

Studies on childhood schizophrenia have not yet revealed whether the condition is more or less prevalent among men or women or among specific ethnic groups. Nonetheless, the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses Study) study in 2006 revealed that psychotic disorders tend to occur more commonly among black and minority ethnic groups [6].

Childhood schizophrenia tends to have a worse prognosis than the adult type and is associated with a very insidious presentation. On the other hand, adult-type schizophrenia with an onset in adolescents may have an acute or insidious presentation. Early onset schizophrenia is generally associated with worse outcomes.

Children and adults with schizophrenia share many of the neural, physiological and neuropsychological characteristics of the disease, although children tend to have more severe manifestations. Childhood schizophrenia also opens interesting research avenues for broader investigations into the disease process of schizophrenia as a whole. Studies indicate that children with schizophrenia have more conspicuous abnormalities in brain development relative to patients who display their first psychotic episodes after puberty. Structural magnetic resonance imaging of the brain in adolescents between the ages of 14 to 18 has shown significant enlargements of the ventricles, implying an associated decrease in the volume of overall brain cells [7] [8]. Brain tissue loss was so severe, that it was estimated that adolescents with schizophrenia had already lost almost 4 times the amount of brain tissue in the frontal lobes compared to normal subjects. Brain loss does not occur haphazardly, but rather in a predictable pattern that begins in the occipital and parietal cortices, in areas known to be involved in perception and attention, and further spreads frontally, involving areas of the brain responsible for executive functions such as planning and organization [9]. Tissue shrinkage in the parietal cortex has been mostly associated with environmental factors, indicating that the trigger for the disease is most likely to be caused by the environment. On the other hand, the pattern of brain matter loss in the frontal cortex is more similar to what is observed in adult schizophrenia patients. Nonetheless, researchers suggest that even adult subjects with schizophrenia may have already undergone a similar process during their adolescence but, because of the absence of accompanying symptoms, it may not have been detected.

Currently there are no preventive measures for childhood schizophrenia, although ongoing research may yield interesting findings [12] [13].

Childhood schizophrenia is a particular form of schizophrenia that affects children younger than 12 [1] [2]. The etiological factors underlying the disease are still not completely elucidated, but it is thought that a combination of genetic predisposition, prenatal insults and environmental stress are responsible. Patients usually present with positive and negative symptoms that are typical of the disease seen in adults, although delusional beliefs and visual hallucinations are less prominent [3]. Treatment is with atypical antipsychotics as well as supportive and cognitive behavioral therapy. Childhood schizophrenia generally has a worse prognosis than adult schizophrenia.

Childhood schizophrenia is a form of schizophrenia that develops in children younger than 12. Schizophrenia is a debilitating psychiatric disorder that manifests with a multitude of symptoms that include hallucinations, delusional beliefs, disorganized speech and behavior as well as cognitive decline. Diagnosis is usually clinical, although the physician may perform laboratory tests to rule out other causes. Childhood schizophrenia is treated with a combination of medications and therapy. It generally has a worse prognosis than adult onset schizophrenia.

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