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Childhood Schizophrenia

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Diagnostic Issues and DSM-IV Criteria. The DSM-IV states that the essential symptoms of schizophrenia are delusions, hallucinations, disorganized speech, grossly ... – PowerPoint PPT presentation

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Title: Childhood Schizophrenia


1
Childhood Schizophrenia
  • Chapter 21
  • Robert F. Asarnow

2
Historical Background and Terminological and
Conceptual Issues
  • 1930s The construct of childhood schizophrenia
    included children who today would receive DSM-IV
    diagnoses of autistic disorder, pervasive
    developmental disorders (PDDs), schizophrenia, or
    disintegrative psychosis.
  • 1960s 1970s Children with schizophrenia had
    hallucinations, delusions, and formal thought
    disorder.
  • DSM-III, DSM-III R and DSM-IV Diagnostic
    criteria for schizophrenia in children was
    identical to those used for adults, with minor
    allowances made for how specific symptoms may be
    manifested in childhood.

3
Diagnostic Issues and DSM-IV Criteria
  • The DSM-IV states that the essential symptoms of
    schizophrenia are delusions, hallucinations,
    disorganized speech, grossly disorganized or
    catatonic behavior, and negative symptoms
    (American Psychiatric Association, 1994, p. 285).
  • Taking child development into account, important
    to differentiate common childhood phenomena such
    as imaginary friends, magical thinking, and
    hypnagogic experiences from true delusions and
    hallucinations.

4
Differential Diagnostic Issues
  • Making a differential diagnosis involving
    schizophrenia in children requires ruling out the
    following psychiatric conditions
  • Mood disorders, schizoaffective disorder, PDDs,
    communication disorders, obsessive compulsive
    disorder, posttraumatic stress disorder,
    dissociative disorders, and medical conditions
    such as seizure disorders, brain tumors, and
    substance abuse.
  • Prevalence
  • Very rare resulted in considerable uncertainty
    about its prevalence.
  • Prior to 12 years of age the prevalence rate of
    such true COS is fewer than 1 in 10,000 (Burd
    Kerbeshian, 1987).

5
Developmental Progression and THE Prodromal
Phase
  • Outcome
  • In general, outcomes in children with
    schizophrenia are generally worse than when onset
    is in adulthood (Remschmidt Theisen, 2005).
  • Sex Differences
  • Excess of boys to girls when onset of
    schizophrenia is prior to 12 years of age.
  • Nearly equal when onset of schizophrenia is after
    age 12.
  • Comorbidity
  • Most common comorbid diagnoses in children are
    conduct/oppositional behaviors and atypical
    depression or dysthymic disorder.

6
Overlap between Autism and COS
  • Considerable body of biological research pointing
    to overlap between autism and COS.
  • It appears that in autism there is acceleration
    or excess of early postnatal brain development
    (13 years), whereas in COS there is exaggeration
    of the brain maturation process of childhood and
    early adolescence (1016 years). While autism and
    COS have been distinguished at the level of
    clinical symptoms, since DSM III the results of
    genetic and brain imaging studies indicate that
    there is overlap in the neurobiological
    substrates for these disorders (Rapoport et al.,
    2009, p.14).

7
Risk Factors
  • Population-Based Studies
  • First-degree relatives of patients with
    adult-onset of schizophrenia is greater
  • Familial aggregation of schizotypal personality
    disorder
  • Concordance rates for schizophrenia are 55.8
    among monozygotic twins and 13.5 among dizygotic
    twins
  • Specific Genes
  • Linkage studies Susceptibility genes have been
    identified including dysbindin, neuregulin-1,
    DISC1, G72, and the alpha 7 nictotinic receptor
    subunit
  • Cytogenetic Abnormalities
  • Rare structural variants
  • Endophenotypes
  • Abnormalities in smooth pursuit eye-movements,
    neurocognitive functioning, brain structure,
    brain electrical activity, and autonomic activity

8
Risk Factors
  • Conclusions Regarding Genetic Findings
  • High phenotypic variation presents challenges in
    mapping the pathways from gene to disorder
  • Little known about the normal function of
    putative susceptibility genes for schizophrenia
    or how they may affect processes related to the
    development of schizophrenia
  • Drug Abuse
  • Adolescents with a genetic predisposition for
    schizophrenia are more likely to develop
    psychotic symptoms and/or show a greater
    psychotic response to cannabis, amphetamines,
    cocaine, and psychomimetic drugs
  • Obstetric Complications
  • Development of schizophrenia in adult life was
    doubled in people with a history of obstetric
    complications
  • Parent and Family Characteristics
  • Dysfunctional family-rearing environments
  • Maladaptive parent communication patterns

9
Risk Factors
  • Brain Structure
  • 9.2 reduction in total brain volume
  • Progressive loss of brain tissue starting from
    the back of the brain and spreading forward
  • Neurocognition
  • Presence of cognitive impairments is the most
    robust finding when schizophrenia patients are
    compared to healthy controls
  • Neural Networks in Schizophrenia
  • COS patients show the same general pattern of
    neuroanatomic and cognitive findings as patients
    with adult onset of schizophrenia

10
Treatment
  • Same antipsychotic medications that are used to
    treat adults with schizophrenia are used to treat
    children and adolescents with schizophrenia
  • Because of serious side effects clozapine is
    usually used only when patients have not
    responded to other antipsychotic treatments.

11
Theoretical Synthesis and Future Directions
  • COS may represent a severe, highly genetic, and
    biologically homogeneous form of schizophrenia in
    which the biological substrate is more clearly
    discernible than in adult-onset schizophrenia.
  • This framework sets the stage for challenging
    questions
  • What causes a small number of children to develop
    schizophrenia very early in life?
  • What triggers the onset of psychotic symptoms?
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