Adolescent Medicine
Schizophrenia
Schizophrenia is one of the most complex of all
mental health disorders. It is a severe, chronic, and disabling
disturbance of the brain that causes distorted thinking, strange
feelings, and unusual behavior and use of language and words.
There is no known single cause responsible for
schizophrenia. It is believed that a chemical imbalance in the brain is
an inherited factor which is necessary for schizophrenia to develop.
However, it is likely that many factors - genetic, behavioral, and
environmental - play a role in the development of this condition.
Schizophrenia is considered to be multifactorially
inherited. Multifactorial inheritance means that "many factors" are
involved. The factors are usually both genetic and environmental, where
a combination of genes from both parents, in addition to unknown
environmental factors, produce the trait or condition. Often, one
gender (either males or females) is affected more frequently than the
other in multifactorial traits. There appears to be a different
threshold of expression, which means that one gender is more likely to
show the problem, over the other gender. Slightly more males develop
schizophrenia in childhood; however, by adolescence, schizophrenia
affects males and females equally.
Schizophrenia is uncommon in children under the
age of 12 and hard to identify in the early phases. A sudden onset of
the psychotic symptoms of schizophrenia frequently occurs in middle to
late adolescence. Statistics indicate that schizophrenia affects
approximately 2.4 million Americans. A child born into a family with
one or more family members affected by schizophrenia has a greater
chance of developing schizophrenia than a child born into a family with
no history of schizophrenia.
After a person has been diagnosed with
schizophrenia in a family, the chance for a sibling to also be
diagnosed with schizophrenia is 7 to 8 percent. If a parent has
schizophrenia, the chance for an adolescent to have the disorder is 10
percent. Risks increase with multiple affected family members.
In adolescents with schizophrenia, behavior
changes may occur slowly, over time, or have a sudden onset. The
adolescent may gradually become more shy and withdrawn. They may begin
to talk about bizarre ideas or fears and begin to cling more to
parents. One of the most disturbing and puzzling characteristics of
schizophrenia is the sudden onset of its psychotic symptoms.
"Psychotic" refers to ideas, perceptions, or feelings that are grossly
distorted from reality. The following are the most common symptoms of
schizophrenia. However, each adolescent may experience symptoms
differently.
Early warning signs of schizophrenia in adolescents may include:
- distorted perception of reality (difficulty telling dreams from reality)
- confused thinking (i.e., confusing television with reality)
- detailed and bizarre thoughts and ideas
- suspiciousness and/or paranoia (fearfulness that someone, or something, is going to harm them)
- hallucinations (seeing, hearing, or feeling things that are not real such as hearing voices telling them to do something)
- delusions (ideas that seem real but are not based in reality)
- extreme moodiness
- severe anxiety and/or fearfulness
- flat affect (lack of emotional expression when speaking)
- difficulty in performing schoolwork
- social withdrawal (severe problems in making and keeping friends)
- disorganized or catatonic behavior (suddenly becoming agitated and confused, or sitting and staring, as if immobilized)
- odd behaviors (i.e., an older child may regress significantly and begin acting like a younger child)
The symptoms of schizophrenia are often classified
as positive (symptoms including delusions, hallucinations, and bizarre
behavior), negative (symptoms including flat affect, withdrawal, and
emotional unresponsiveness), disorganized speech (including speech that
is incomprehensible), and disorganized or catatonic behavior (including
marked mood swings, sudden aggression, or confusion, followed by sudden
motionlessness and staring). The symptoms of schizophrenia in
adolescents are similar to adults, however, adolescents, more often (in
80 percent of diagnosed cases), experience auditory hallucinations and
typically do not experience delusions or formal thought disorders until
mid-adolescence or older. The symptoms of schizophrenia may resemble
other problems or psychiatric conditions. Always consult your
adolescent's physician for a diagnosis.
Schizophrenia in children and adolescents is
usually diagnosed by a child and adolescent psychiatrist. Other mental
health professionals usually participate in the completion of a
comprehensive mental health evaluation to determine individualized
treatment needs.
Specific treatment for schizophrenia will be determined by your adolescent's physician based on:
- your adolescent's age, overall health, and medical history
- extent of the condition
- type of schizophrenia
- your adolescent's tolerance for specific medications or therapies
- expectations for the course of the condition
- your opinion or preference
Schizophrenia is a major psychiatric illness.
Treatment for schizophrenia is complex. A combination of therapies is
often necessary to meet the individualized needs of the child or
adolescent with schizophrenia. Treatment is aimed at reducing the
symptoms associated with the disorder. Types of treatment that may be
helpful to a child or adolescent with schizophrenia may include:
- medications (also called psychopharmacological management; to reduce the symptoms of schizophrenia), including the following:
- antipsychotic medications (previously known as "neuroleptics") -
medications that act against the symptoms of psychotic illness, but do
not cure the illness. This specialized class of medications can reduce
symptoms or reduce the severity of symptoms, and is used primarily to
treat the pervasive, intrusive, and disturbing thoughts of a person
with schizophrenia. They are designed to help minimize the severity of
delusions and hallucinations the adolescent is experiencing.
- mood stabilizing agents, such as lithium or valproic acid, especially in the initial phase of an illness episode
- individual and family psychotherapy (including supportive, cognitive, and behavioral therapy)
- specialized educational and/or structured activity programs
(i.e., social skills training, vocational training, speech and language
therapy)
- self-help and support groups
Preventive measures to reduce the incidence of
schizophrenia are not known at this time. However, identification and
early intervention can improve the quality of life experienced by
children and adolescents with schizophrenia. Further, treatment is most
successful when symptoms of the first psychotic episode are addressed
properly and promptly. It is crucial for an adolescent who is
prescribed medications for the treatment of schizophrenia to remain
adherent to the regimen. Dosages and types of medications may need to
be adjusted periodically to maintain effectiveness. Always consult your
adolescent's physician for more information.
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Disclaimer:
This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.
Last reviewed on 10/4/2006