Schizophrenia in children
introduction
Schizophrenia typically begins in young adulthood, but there are also patients who show symptoms in childhood.
In fact, schizophrenia is believed to have roots in most people with childhood, but usually doesn't show up until years or decades later. Since the symptoms in such young people usually express themselves differently than in adults and childhood schizophrenia is very rare, diagnosis is often difficult.
Causes of schizophrenia in children
The causes and triggers of schizophrenia are not yet fully understood, but in principle independent of the age of onset.
It is known that schizophrenia in adults and children is caused by a number of unfavorable risk factors. According to this, the susceptibility to psychosis is increased, for example, by:
- Genetic predisposition
- Damage to the brain structure
- Sub-optimal development of the brain
As a result of these disorders, there is, among other things, an imbalance in the messenger substances in the brain, above all in dopamine metabolism. Complications in pregnancy or childbirth are also discussed as influencing factors. The first symptoms appear in adults when a trigger such as stress or drug use occurs in addition to these prior stresses.
If the basic risk factors are particularly pronounced or if a stressor occurs very early on, the disease can also come to light in childhood. In some cases these triggers can be determined, e.g. if the child is mistreated or otherwise traumatized. Many of the young patients were previously healthy and apparently fall ill out of nowhere.
Since childhood schizophrenia is a rare disease, much is still unknown.
Find out more about the topic here: Causes of Schizophrenia.
frequency
About 1% of all Germans suffer from at least one episode of schizophrenic psychosis, most of them fall ill between the ages of 20-25. Only 4% of all schizophrenia patients show symptoms before the age of 15, less than 1% before the age of 10. Since the diagnosis of children is often delayed, the numbers could be a little higher than one currently suspects. Nevertheless, childhood schizophrenia is a very rare disease.
You may also be interested in this topic: Inheritance of schizophrenia
Concomitant symptoms
As in adults, children with schizophrenia not only show the typical positive symptoms, such as:
- Delusion
- Hallucinations
- Feeling of mind control
Negative symptoms can also occur, for example:
- Emotional cushioning
- Lack of drive and interest
- Cognitive decline
The younger the child, the more unspecific or more hidden it shows the symptoms. Positive symptoms therefore initially look like a particularly blooming imagination, negative symptoms are often initially interpreted as tiredness or exhaustion.
Schizophrenia actually leads to side symptoms such as exhaustion, difficulty concentrating and in pronounced cases also to developmental delays, which are often noticed earlier than the actual schizophrenia.
Motor problems, i.e. movement disorders, can also be accompanying symptoms. In psychotic attacks, patients often show excessive movements that express themselves as tic disorders. In the case of pronounced negative symptoms, there is also a sedentary lifestyle after the attack, the child appears stiff and immobile, the facial expressions and gestures come to a standstill in line with the emotional indifference.
Find out more here: Symptoms of schizophrenia
diagnosis
There is no specific schizophrenia test for either adults or children. The diagnosis therefore consists of querying or observing typical symptoms and various more unspecific tests which, among other things, check cognitive abilities. Also, imaging and further tests must always be done to rule out other causes of the symptoms.
Tests are also carried out on children to assess their psychological and physical development.
What tests are there?
As already mentioned, the diagnosis of schizophrenia is made by recording symptoms. There are also standardized tests, for example in the form of questionnaires, which in principle ask the same question as the doctor in the patient interview. However, these are designed for adults and are only used to record risk, so they cannot replace a consultation with a doctor.
Such questionnaires can be adapted according to the age of the child, but are rarely used. As a rule, tests to record cognitive performance and the like are therefore used, but no specific schizophrenia tests.
Continue reading: How can you test for schizophrenia?
How do parents know that their child has schizophrenia?
Unfortunately, only very severe schizophrenic diseases are so noticeable that psychiatric treatment is considered. For example, if the child describes their hallucinations or wants to hurt themselves or others, the parents very quickly notice that something is wrong. For example, if he hears voices that are not there or speaks of imaginary friends giving him instructions, a psychiatrist is usually called in quickly.
If the symptoms are less pronounced, they can easily be misinterpreted, e.g. as a very pronounced fantasy or as ordinary mood swings. However, if the child's symptoms cause problems, for example at school, or if there are signs of a developmental delay, they should be presented to a doctor anyway. This should then think of a psychiatric problem and initiate the diagnosis.
It is therefore only possible for the parents to recognize schizophrenia themselves if the child shows very severe symptoms, otherwise this is the task of the doctor.
Find out more about the topic here: The signs of impending schizophrenia.
Treatment for schizophrenia
If the symptoms are pronounced, they should be instructed in child and adolescent psychiatry in order to prevent the child from endangering others and themselves and to ensure optimal conditions for finding therapy.
The most effective treatment for schizophrenia is the use of antipsychotic drugs (e.g. haloperidol, clozapine). These are almost exclusively approved for adults, but can, if necessary, be prescribed by the doctor “off-label”, i.e. outside the approved area. Alternative substances are risperidone or ziprasidone, which are not directly approved for schizophrenia, but at least for the age group, but then also have to be used formally "off-label".
Psychotherapy and alternative approaches can also be used in children, but they only support drug treatment. After the acute episode, the child can be discharged if a suitable drug has been found in the lowest effective dose. As a rule, the intake should be continued for a longer period in order to avoid relapses.
If the relapse was mild, the drug can be discontinued after a while under the supervision of a doctor. If the psychosis was very pronounced, lifelong medication is often required.
Read more on the topic: Therapy for schizophrenia
Duration of childhood schizophrenia
As in adults, the duration of an attack depends on whether and how it is treated and therefore varies from a few weeks to several months. Schizophrenia in general can, depending on its shape and severity, disappear again after the first attack, trigger several attacks or last for a lifetime.
It is therefore not possible to make a general statement about the duration of childhood schizophrenia, as this varies greatly from person to person.
Read more on the topic: Can schizophrenia be cured?
Can childhood schizophrenia be cured?
There is no cure for schizophrenia because there are currently no causal therapies, only symptom-relieving therapies. In many cases, the symptoms go away on their own.
If it is mildly developed, childhood schizophrenia has a similar, if not better, prognosis than in adulthood. If the symptoms are severe, the prospects for a life without schizophrenia are worse than in adults, since the early onset of the disease in childhood reflects the particular severity of the disease.
