Childhood schizophrenia

Diagnostic and Statistical Manual of Mental Disorders against childhood schizophrenia. Childhood schizophrenia was not directly added to the DSM until 1968, when it was added to the DSM-II, which set forth diagnostic criteria similar to that of adult schizophrenia. "Schizophrenia, childhood type" was a DSM-II diagnosis with diagnostic code 295.8, In the DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000), DSM-5 (2013) there is no "childhood schizophrenia". The rationale for this approach was that, since the clinical pictures of adult schizophrenia and childhood schizophrenia are identical, childhood schizophrenia should not be a separate disorder. However, the section in schizophrenia's Development and Course in DSM-5, includes references to childhood-onset schizophrenia. "Childhood type schizophrenia" available in the Soviet adopted version of the ICD-9 (code 299.91) and the Russian adopted version of the 10th revision ICD-10 (code F20.8xx3) and the U.S. adopted the 10th revision ICD-10 (code F20.9x6) classified "schizophrenia, unspecified". ==Signs and symptoms==

Schizophrenia is a mental disorder that is expressed in abnormal mental functions, a loss of one's sense of identity and self, a compromised perception of reality, and disturbed behavior. The signs and symptoms of childhood schizophrenia are similar to those of adult-onset schizophrenia. Some of the earliest signs that a young child may develop schizophrenia are lags in language and motor development. Some children engage in activities such as flapping the arms or rocking, and may appear anxious, confused, or disruptive on a regular basis. Children may experience hallucinations, but these are often difficult to differentiate from just normal imagination or child play. Visual hallucinations are more commonly found in children than in adults. schizophrenia especially difficult to diagnose in the earliest stages. The cognitive abilities of children with schizophrenia may also often be lacking, with 20% of patients showing borderline or full intellectual disability. Negative symptoms include apathy, avolition, alogia, anhedonia, asociality, and blunted emotional affect. • Apathy is an overall lack of interest or enjoyment, which relates to the negative symptom of blunted emotional affect. • Blunted emotional affect includes a lack of facial expressions, lack of intonation while speaking, and little eye contact. If you are speaking to someone who has blunted emotional affect, it would be difficult to determine their feelings using their facial expressions and tone. • Avolition is experienced when the child shows few goal-focused behaviors and choices, and a lack of interest in goal-related activities, including personal hygiene. • Alogia can be seen when people use few words and lack fluency while speaking. • Anhedonia relates to an inability to find pleasure in activities that one previously found enjoyable, as well as the inability to remember previous enjoyable memories. • Asociality is a symptom seen when a person has no interest in socializing with others. These negative symptoms can severely impact children's and adolescents' abilities to function in school and in other public settings. Very early-onset schizophrenia refers to onset before the age of thirteen. The prodromal phase, which precedes psychotic symptoms, is characterized by deterioration in school performance, social withdrawal, disorganized or unusual behavior, a decreased ability to perform daily activities, a deterioration in self-care skills, bizarre hygiene and eating behaviors, changes in affect, a lack of impulse control, hostility and aggression, and lethargy. ==Pathogenesis ==

Several environmental factors, including perinatal complications and prenatal maternal infections may contribute to the etiology of schizophrenia. Severity or frequency of prenatal infections may also contribute to earlier onset of symptoms by means of congenital brain malformations, reduction or impairment of cognitive function, and psychological disorders. While it is hard to detect, there are relatives who are more-likely to be diagnosed with schizophrenia if they are children of individuals who have this disorder. "First degree relatives" are found to have the highest chance of being diagnosed with schizophrenia. Children of individuals with schizophrenia have a 8.2% chance of having schizophrenia while the general population is at an 0.86% chance of having this disorder. These results indicate that genes play a big role in one developing schizophrenia. Genetic There is "considerable overlap" in the genetics of childhood-onset and adult-onset schizophrenia, but in childhood-onset schizophrenia there is a higher number of "rare allelic variants". There have been several genes indicated in children diagnosed with schizophrenia that include: neuregulin, dysbindin, D-amino acid oxidase, proline dehydrogenase, catechol-Omethyltransferase, and regulator of G protein signaling. There have also been findings of 5HT2A and dopamine D3 receptor. An important gene for adolescent-onset schizophrenia is the catechol-O-methyltransferase gene, a gene that regulates dopamine. Children with schizophrenia have an increase in genetic deletions or duplication mutations and some have a specific mutation called 22q11 deletion syndrome, which accounts for up to 2% of cases. Neuroanatomical Neuroimaging studies have found differences between the medicated brains of individuals with schizophrenia, and the brains of those without, though research does not know the cause of the difference. In childhood-onset schizophrenia, there appears to be a more rapid loss of cerebral grey matter during adolescence. Studies have reported that adverse childhood experiences (ACEs) are the most preventable cause of the development of psychiatric disorders such as schizophrenia. ACEs have the potential to impact on the structure and function of the brain; structural changes revealed have been related to stress. Findings also report that different areas of the brain are affected by different types of maltreatment. ==Diagnosis==

The same criteria are used to diagnose children and adults. Laboratory tests include electroencephalogram EEG screening and brain imaging scans. Blood tests are used to rule out alcohol or drug effects, In children hallucinations must be separated from typical childhood fantasies. Childhood schizophrenia can be difficult to diagnosis simply because of how many disorders mimic the symptoms of CS. Though it can be difficult, that is why it is important to examine the whole mental state of the child at that time. Accurate and timely diagnosis is crucial, as misdiagnosis can adversely affect long-term treatment outcomes and prognosis. Individuals who experience disorders such as major depressive disorder, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, delusional disorder and schizotypal personality disorder have all been known to exhibit similar symptoms to children who have been diagnosed with CS. The three most common disorders that are difficult to distinguish are bipolar disorder (BD), autism spectrum disorder (ASD), and attention deficit hyperactive disorder (ADHD). BD, ASD, and ADHD overlap with symptom patterns in CS but a few distinguishing factors helps differentiate the disorders. Understanding these differences is crucial to diagnosing the child. Individuals with bipolar disorder and childhood schizophrenia can both present psychotic symptoms such as hallucinations, delusions, and disorganized behaviors. A distinguishing feature in childhood schizophrenia, the hallucination, aren't taking place during a 'depressive or manic' episode as it would for an individual diagnosed with bipolar disorder. An individual with bipolar disorder has both low and high moods while one with CS exhibits elements of depression. Autism spectrum disorder share many features that are present in CS such as disorganized speech, social deficits, and extremely bizarre and repetitive behaviors. A hallmark of CS and distinguishing factor is when hallucinations last longer than one month. Should this occur, further examinations are necessary to determine if the child has ASD or CS. Unlike the previous two disorders, ADHD and CS have fewer commonalities. Both individuals who have been diagnosed with CS and ADHD may appear to exhibit a poor attention span and disorganization. "Psychotic episodes are absent in ADHD, a distinct difference from CS". It is important to understand that children diagnosed with childhood schizophrenia have higher rates of comorbidity, so exploring all resources is necessary to properly diagnose the child. ==Prevention==

Research efforts are focusing on prevention in identifying early signs from relatives with associated disorders similar to schizophrenia and those with prenatal and birth complications. Prevention has been an ongoing challenge because early signs of the disorder are similar to those of other disorders. Also, some of the schizophrenic-related symptoms are often found in children without schizophrenia or any other diagnosable disorder. ==Treatment==

Current methods in treating early-onset schizophrenia follow a similar approach to the treatment of adult schizophrenia. Although methods of treatment for childhood schizophrenia are largely understudied, the use of antipsychotic medicine is normally the primary line of treatment in addressing signs in childhood schizophrenia diagnoses. Contemporary practices of schizophrenia treatment are multidisciplinary, recuperation oriented, and consist of medications, with psychosocial interventions that include familial support systems. However, research has shown that atypical antipsychotics may be preferable because they cause less short-term side effects. When weighing treatment options, it is necessary to consider the adverse effects, such as metabolic syndrome, of various medications used to treat schizophrenia and the potential implications of these effects on development. A 2013 systematic review compared the efficacy of atypical antipsychotics versus typical antipsychotics for adolescents: Madaan et al. wrote that studies report efficacy of typical neuroleptics such as thioridazine, thiothixene, loxapine and haloperidol, high incidence of side effects such as extrapyramidal symptoms, akathisia, dystonias, sedation, elevated prolactin, tardive dyskinesia. ==Prognosis==

A very-early diagnosis of schizophrenia leads to a worse prognosis than other psychotic disorders. The primary area that children with schizophrenia must adapt to is their social surroundings. It has been found, however, that very early-onset schizophrenia carried a more severe prognosis than later-onset schizophrenia. Regardless of treatment, children diagnosed with schizophrenia at an early age have diminished social skills, such as educational and vocational abilities. The grey matter in the cerebral cortex of the brain shrinks over time in people with schizophrenia; the question of whether antipsychotic medication exacerbates or causes this has been controversial. A 2015 meta-analysis found that there is a positive correlation between the cumulative amount of first generation antipsychotics taken by people with schizophrenia and the amount of grey matter loss, and a negative correlation with the cumulative amount of second-generation antipsychotics taken. ==Epidemiology==

Schizophrenia disorders in children are rare. There is often a disproportionately large number of males with childhood schizophrenia, because the age of onset of the disorder is earlier in males than females by about 5 years. While very early-onset schizophrenia is a rare event, with prevalence of about 1:40,000, early-onset schizophrenia manifests more often, with an estimated prevalence of 0.5%. ==History==

Until the late nineteenth century, children were often diagnosed with psychosis like schizophrenia, but instead were said to have "pubescent" or "developmental" insanity. Through the 1950s, childhood psychosis began to become more and more common, and psychiatrists began to take a deeper look into the issue. De Sanctis characterized the condition by the presence of catatonia. Philip Bromberg thinks that "dementia praecocissima" is in some cases indistinguishable from childhood schizophrenia; Leo Kanner believed that "dementia praecocissima" encompassed a number of pathological conditions. In ICD-11 Heller syndrome is classed as an autism spectrum subtype. In 1909, Julius Raecke reported on ten cases of catatonia in children at the Psychiatric and Neurological Hospital of Kiel University, where he worked. He described symptoms similar to those previously recorded by Dr. Karl Ludwig Kahlbaum, including "stereotypies and bizarre urges, impulsive motor eruptions and blind apathy." recounts a case study of a boy who manifested "typical catatonia" from the age of twelve, characterizing him as showing a "clear picture of schizophrenia." Before 1980 the literature on "childhood schizophrenia" often described a "heterogeneous mixture" of different disorders, such as autism, "symbiotic psychosis" or psychotic disorder other than schizophrenia, pervasive developmental disorders and dementia infantilis. == References ==