Childhood-Onset Schizophrenia Carolyn R. Fallahi, Ph. D.

Transcription

1 Childhood-Onset Schizophrenia Carolyn R. Fallahi, Ph. D.

2 What is Schizophrenia? Severe Chronic Neurological disorder Debilitating Hallucinations Delusions Grossly disturbed behavior Usually first appears during late adolescence or early adulthood. However, children can experience an early onset = child-onset Schizophrenia.

3 In the late 1800s Emil Kraepelin = dementia praecox. History 1911 Eugene Bleuler = schizophrenia Split mind not the best term. 1970s Kolvin several disorders were distinguished from childhood schizophrenia, e.g. autism and the PDD.

4 Diagnosis and Assessment Symptoms of Schizophrenia for adults versus children. The symptoms are divided into positive versus negative symptoms. Positive = distortions of normal brain functioning and are considered psychotic symptoms. Hallucinations are examples. Negative = loss of normal functions. For example = social withdrawal, lack of emotional responding, and loss of motor control.

5 Differences with Children To make the diagnosis, children do not have to experience positive and negative symptoms, although most do. A child must experience continuous signs of disturbance for at least 6 months, with at least one month of symptoms that include delusions, hallucinations, disorganized speech (derailment or incoherence), grossly disorganized or catatonic behavior, or negative symptoms (affective flattening, alogia, avolition).

6 Terms Derailment Incoherence Affective flattening Alogia Avolition

7 Paranoid Type Disorganized Type Catatonic Type Undifferentiated Type Residual Type Types of Schizophrenia

8 Controversy with Child-Onset Is childhood-onset Schizophrenia the same disorder as adult-onset? The prevailing theory through the 1970s: neurological changes occurring during late adolescence switched on schizophrenia in some people who were genetically susceptible to it. Evidence that they are in fact the same disorder?

9 Symptoms of children with Positive symptoms Hallucinations Visual hallucinations Auditory hallucinations Command hallucinations Olfactory hallucinations Gustatory hallucinations Schizophrenia

10 Frequency of hallucinations Auditory: 75-80% Visual: 20-30% Children s hallucinations are less organized

11 Delusions Delusions = false beliefs that a child holds onto persistently, despite evidence that they are not accurate. Persecutory delusions Referential delusions About half of children with schizophrenia experience delusions.

12 Disorganized speech Disordered thinking Illogical thinking Incoherence of thought Loosening of associations Poverty of thought Grossly disorganized behavior Symptoms

13 Negative symptoms Negative symptoms represent a loss of normal functions. Three principal negative symptoms of Schizophrenia: Flattened affect (loss of emotion) Alogia (loss of communication) Avolition (loss of purposeful behavior)

14 Prevalence The estimated prevalence in the adult population is about 1%. In children between 11 and 15, it is estimated to be about 1.4 in 10,000, and under the age of 11, 1-5 children in 100,000.

15 Premorbid Functioning What are the typical symptoms? They are described as odd, anxious and isolative. They have odd social behaviors, motor abnormalities, delays in language, and transient symptoms of autism. Academic problems.

16 Neurobiological Dysfunctions Etiology Brain morphology (form and structure of the brain). MRI differences in the average brain size of children with Schiz vs. normals. The lateral ventricles The total cerebral volume and the volume of the cerebellum. Brain functioning. Neurotransmitters: Dopamine (Dopamine Hypothesis) and Serotonin

17 Genetics Why the neurobiological dysfunction? Gottesman (1991) looked at 40 family and twin studies and found a general risk for schizophrenia. Viral Infections A virus could influence the development of schiz in many ways.

18 Therapeutic Interventions Antipsychotic medications: 98% receive medication and between 45% and 85% receive more than 1 medication. Antipsychotics are grouped into 2 groups: Typical Atypical But.children have a lot of side-effects. Why?

19 Side Effects Extrapyramidal system: neural pathways that connects the brain to the motor neurons in the spinal cord. Muscular rigidity Agitation Tremors Involvuntary muscle movements Tardive dyskinesia

20 Psychological Interventions Help the child and family cope. Reintegration into school/community. Psychoeducational interventions Importance of maintaining a healthy lifestyle with medication, proper diet, sufficient sleep, and healthy relationships. Social skills training. Appropriate educational placement. Partial hospitalization. Coping strategies