FAQ Mental Health April 2004

April 2004

Q: What is schizophrenia and can it occur in children?

A: Schizophrenia is a psychotic disorder that is characterized by gross distortions of reality; withdrawal from appropriate social interactions; and disorganization and fragmentation of perception, thought, and emotion. Although schizophrenia sometimes begins as an acute psychotic episode in young adults, it emerges gradually in children, often preceded by developmental disturbances, such as lags in motor and speech/language development. Such problems tend to be associated with more pronounced brain abnormalities. Schizophrenia is rare in children, affecting only about 1 in 40,000 compared with 1 in 100 in adults.

Children with schizophrenia often see or hear things that don't really exist and harbor paranoid and bizarre beliefs. For example, they may think that people are plotting against them or can read their minds. Other symptoms of the disorder include problems paying attention; impaired memory and reasoning; speech impairments; inappropriate, or flattened, expression of emotion; poor social skills; and depressed mood. Such children may laugh at a sad event, make poor eye contact, and show little body language or facial expression.

Misdiagnosis of schizophrenia in children is all too common. It is distinguished from autism-which is usually diagnosed by age 3-by the persistence of hallucinations and delusions for at least 6 months and by a later age of onset-7 years or older. Parents may have reason for concern if a child of 7 years or older often hears voices saying derogatory things about him or her, hears voices conversing with one another, talks to himself or herself, stares at scary things-snakes, spiders, shadows-that aren't really there, and shows no interest in friendships.

Although it's unclear whether schizophrenia has a single or multiple underlying causes, evidence suggests that it is a neurodevelopmental disease likely involving a genetic predisposition, a prenatal insult to the developing brain, and stressful life events?especially abuse and neglect. It is often a co-morbid disorder with substance abuse, conduct disorder, and antisocial personality disorder.

Diagnostic Criteria for Schizophrenia

A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated)

(1) delusions

(2) hallucinations

(3) disorganized speech (e.g., frequent derailment or incoherence)

(4) grossly disorganized or catatonic behavior

(5) negative symptoms (i.e., affective flattening, alogia, or avolition)

Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behaviors or thoughts, or two or more voices conversing with each other.

B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).

C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6 month period must include at least 1 month of symptoms (or less if successfully treated ) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A are present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective and Mood Disorders exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) No Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

E. Substance and general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

F. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).

Classification of longitudinal course (can be applied only after at least 1 year has elapsed since the initial onset of active-phase symptoms):

• Episodic With Interepisode Residual Symptoms (episodes are defined by the reemergence of prominent psychotic symptoms); also specify if With Prominent Negative Symptoms

• Episodic With No Interepisode Residual Symptoms

• Continuous (prominent psychotic symptoms are present throughout observation); also specify if With Prominent Negative Symptoms

• Single Episode in Partial Remission ; also specify if With Prominent Negative Symptoms

• Single Episode in Full Remission

• Other or Unspecified Pattern

What Can Family Members, Friends, and Teachers Do?

Become really informed about schizophrenia and help the youth understand that schizophrenia can be treated (go see the movie A Beautiful Mind ).

Proactively encourage youth to maintain a healthy lifestyle including a healthy diet; regular, vigorous exercise; appropriate amounts of rest and sleep; stress management; and avoidance of alcohol and drugs.

What Can Mental Health Providers Do?

• Psychosocial Therapy

• Psychoeducational Therapy

• Cognitive Behavioral Strategies and Social Skills Training

• Family Intervention Programs

• Medication Therapy

• Antipsychotics ( olanzapine and clozapine)

Technical Assistance Partnership for Child and Family Mental Health

Mental Health and Systems of Care Frequently Asked Questions

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	April 2004 Q: What is schizophrenia and can it occur in children? A: Schizophrenia is a psychotic disorder that is characterized by gross distortions of reality; withdrawal from appropriate social interactions; and disorganization and fragmentation of perception, thought, and emotion. Although schizophrenia sometimes begins as an acute psychotic episode in young adults, it emerges gradually in children, often preceded by developmental disturbances, such as lags in motor and speech/language development. Such problems tend to be associated with more pronounced brain abnormalities. Schizophrenia is rare in children, affecting only about 1 in 40,000 compared with 1 in 100 in adults. Children with schizophrenia often see or hear things that don't really exist and harbor paranoid and bizarre beliefs. For example, they may think that people are plotting against them or can read their minds. Other symptoms of the disorder include problems paying attention; impaired memory and reasoning; speech impairments; inappropriate, or flattened, expression of emotion; poor social skills; and depressed mood. Such children may laugh at a sad event, make poor eye contact, and show little body language or facial expression. Misdiagnosis of schizophrenia in children is all too common. It is distinguished from autism-which is usually diagnosed by age 3-by the persistence of hallucinations and delusions for at least 6 months and by a later age of onset-7 years or older. Parents may have reason for concern if a child of 7 years or older often hears voices saying derogatory things about him or her, hears voices conversing with one another, talks to himself or herself, stares at scary things-snakes, spiders, shadows-that aren't really there, and shows no interest in friendships. Although it's unclear whether schizophrenia has a single or multiple underlying causes, evidence suggests that it is a neurodevelopmental disease likely involving a genetic predisposition, a prenatal insult to the developing brain, and stressful life events?especially abuse and neglect. It is often a co-morbid disorder with substance abuse, conduct disorder, and antisocial personality disorder. Diagnostic Criteria for Schizophrenia A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated) (1) delusions (2) hallucinations (3) disorganized speech (e.g., frequent derailment or incoherence) (4) grossly disorganized or catatonic behavior (5) negative symptoms (i.e., affective flattening, alogia, or avolition) Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behaviors or thoughts, or two or more voices conversing with each other. B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement). C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6 month period must include at least 1 month of symptoms (or less if successfully treated ) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A are present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences). D. Schizoaffective and Mood Disorders exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) No Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods. E. Substance and general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. F. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated). Classification of longitudinal course (can be applied only after at least 1 year has elapsed since the initial onset of active-phase symptoms): • Episodic With Interepisode Residual Symptoms (episodes are defined by the reemergence of prominent psychotic symptoms); also specify if With Prominent Negative Symptoms • Episodic With No Interepisode Residual Symptoms • Continuous (prominent psychotic symptoms are present throughout observation); also specify if With Prominent Negative Symptoms • Single Episode in Partial Remission ; also specify if With Prominent Negative Symptoms • Single Episode in Full Remission • Other or Unspecified Pattern What Can Family Members, Friends, and Teachers Do? Become really informed about schizophrenia and help the youth understand that schizophrenia can be treated (go see the movie A Beautiful Mind ). Proactively encourage youth to maintain a healthy lifestyle including a healthy diet; regular, vigorous exercise; appropriate amounts of rest and sleep; stress management; and avoidance of alcohol and drugs. What Can Mental Health Providers Do? • Psychosocial Therapy • Psychoeducational Therapy • Cognitive Behavioral Strategies and Social Skills Training • Family Intervention Programs • Medication Therapy • Antipsychotics ( olanzapine and clozapine)