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Early-Onset Schizophrenia

Schizophrenia is a major psychiatric illness. Symptoms usually begin in late adolescence or early adulthood.

Numerous studies have found that about 1 in every 100 people around the world has the disorder. However, schizophrenia with an onset in adolescence (prior to age 18) is less common, and an onset of the disorder in childhood (before age 13) is exceedingly rare. It is thought that at most one in every 100 adults with schizophrenia develops it in childhood.

Schizophrenia is diagnosed by the presence of two of the symptoms listed. For a diagnosis of schizophrenia, two of these symptoms must be present for at least 6 months and must be accompanied by increased difficulty in daily living in areas such as school, friendships, and self-care.

Hallucinations or delusions in a child should lead to an evaluation by a mental health professional who has experience working with children and adolescents with mental health  disorders. A diagnosis of schizophrenia is made through an interview with the child and parents using information obtained from them and from school personnel.

Many of the symptoms seen in people with schizophrenia are also found in people with depression, bipolar disorder, or other illnesses.

As a result, studies have found that misdiagnosis is common. An additional difficulty in making a diagnosis in children and adolescents relates to the fact that hallucinations are surprisingly common, and, in fact, are most often seen in children and adolescents with diagnoses other than schizophrenia.

Many children with other conditions such as mood disorders and dissociative disorders, report auditory hallucinations when they are under stress. Children with pervasive developmental disorders (autism, Asperger’s disorder) often have social difficulties, disorganized behavior and language impairments.

These develop mental disorders can be confused with a diagnosis of schizophrenia.

Prognosis of early-onset schizophrenia

The outcome for children with schizophrenia varies greatly and some individuals function well with medication. Earlier onset is often associated with a poorer outcome when it interferes with attending school and completing an education. However, because children typically live at home with the combined social environments of family and school, symptoms are often recognized early. This fact is significant because recent studies have suggested that earlier treatment may reduce the decline in functioning and long-term impairments commonly associated with schizophrenia. As such, accurate and early intervention and diagnosis are critical.

Symptoms

Positive symptoms include:

• Hallucinations, usually voices which are critical or threatening

• Delusions, which are firm beliefs that are out of touch with reality and which commonly include the fear that people are watching, harassing, or plotting against the individual

• Disorganized speech, which is often seen as an inability to maintain a conversation, usually as a result of difficulty staying on topic

• Disorganized or catatonic behavior, which can include behavior that is unusual and bizarre, or can be demonstrated by difficulty planning and completing activities in an organized fashion

Negative symptoms include:

• Reduction in emotional expression

• Lack of motivation and energy

• Loss of enjoyment and interest in activities, including social interaction.

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