2. Introduction
• Pediatric schizophrenia, childhood onset
schizophrenia, childhood psychoses (DSM III)
• Dysregulation in thinking, motor, emotional
processess in child and adoloscents under the age
of 18 years
• Rare among children of ages from 7-8 yrs
• 50% of the young schizophrenics will experience
severe neuropsychiatric disturbances in the future
• Diagnostic criteria are same to adult population
• Childhood psychoses was added to DSM III in
1980s.
3. Prevalence & Epidemiology
• Studies using strict Dx criteria are limited
(because of the diagnostic diversity)
• Autism is more prevalent than childhood
schizophrenia
• 2/100,000 (based on the DSM III)
• Male to female ratio= 1.5:1 to 2.5:1
• Diagnosis is made frequently in adults than
children
• The peak age of onset is 15 yrs
4. Clinical features
• Almost similar to the adult schizophrenia
• Earlier signs are developmental lags/ language
and motor delays
• Positive & negative symptoms
• Auditory hallucinations are the most common Sx in
75%
• Visual and somatic hallucinations are not rare but
less frequent when compared to AH.
• Delusions (50-80%) – persecutory, feeling of being
tormented, somatic concerns, grandiose
perception or religious ideation
5. Etiology
• A neurodevelopmental disorder with no
demonstrable single etiology
• Genetic factors:
– Schizophrenia & schizophrenia spectrum ds. are
found in high rate among families of pts with F20
– Concordance rate: monozygotic twins (50%) &
dizygotic twins (17%)
– F20 is genetically mediated but not genetically
determined and results from an interaction of
gene & evmnt.
6. • Neurobiological deficits:
– No clear premorbid personality profile
explanations available
– Enlargement of the ventricular structure &
overall reduction in cortical grey matter and
brain volumes (Brain imaging studies)
• Psychology:
– 10-20% of children with F20 have borderline
IQ
– Cognitive deficits include lowered IQ, low
information processing, sustained
attention, memory and executive functions
especially working memory
7. • Family factors:
–
–
–
–
Abberant communication patterns
Double bound communications
Levels of EE
Communication deviance predispose to develop
schizophrenia in adoloscents
• Environment
– Low SES is associated with higher rate of
schizophrenia
– Adverse life events such as death of a parent,
rejection of the child
– Relationship of schizophrenia onset with SES is
still contradictory
– Incidence of clinical syndrome similar in a variey
of cultural settings
8. Assessment
•
•
•
Evaluate all areas of functioning
Dignostic procedures are often prolonged and require multiple informants
History and development
– History of current difficulties
– Age of onset
– Course and nature of symptoms
– Premorbid functioning
– School & cognitive skills
– Psychosocial adaptive skills
– Precipitants
– History of trauma
– Family H/o
– Family adaptive funtioning
– Substance use H/o
– Developmental H/o
– Communication and speech functioning
9. • Mental status examination:
– Level of consciousness and orientation
– Hallucinations or delusions
– Thought ds & negative symptoms
– Affective symptoms
– Assessment of dangerous and impulsive acts
– Suicidality & homicidality
10. • Psycho logic evaluation
– Projective testing for evaluation of thought
disturbances, hallucinations etc
– IQ and formal educational testing for assessment
of achievement
– Assessment of adaptive skills
– Assessment of communication/speech and
language
• Medical & neurological history and evaluation
• Physical examination for associated medical
conditions
• Toxicology screen for evaluation of substance
abuse
• Neurological consultation including EEG
12. Treatment
• Require a multi-model approach
• Goals:
– ↓ the characteristic ψtic symptoms
– Returning the child to more appropriate lines
of management
– Re-integrating the child into his/her
community
13. Psychopharmacolgoy
• Clozapine is effective than HPL
• Clozapine has S/E of drowsiness, weight
gain, non specific changes in EEG, and
hypersalivation (Wt gain is approximately
7kg/6wks)
• RSPN – weight gain, sedation, and EPS
• OLZ- ↑ appetite, sedation
• Quitiapine- well tollerated in longer term
use/ sustained symptom improvement
14. • Care full practice parameters to be included
in Antipsychotic dosage
• Patient education abt the S/Es and informed
consent
• Baseline monitoring using AIMS for motor
S/Es
• Ongoing monitoring needs for SE of atypical
APs
• A combination of psychoeducational family
Rx + medication Rx + social skill training has
decreased relapse rate
• Support the child and the family with proper
explanations
15. • Supportive and CBT interventions are used to
promote adaptive functioning
• Individual/group interventions focus on
improving conflict resolution, social skills,
problem solving, and ADL
• Advocacy and educational groups are
beneficial- ↓ the stigma, and isolation
experienced by the families.
• School based interventions: spl education to
address the possible learning and
developmental disabilities
• Community based interventions: case
management, in-home therapeutic care,
therapeutic recreational activities and
vocational rehabilitation
16. Prognosis
• Low IQ and poor premorbid functioning- ↓
outcome
• Good prognosis: presence of affective
symptoms, A/c and old age onset, better
premorbid functioning and adjustment
• Poor prognosis: poor premorbid
character, non acute onset and early age
of onset.
