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==Introduction== | ==Introduction== | ||
| − | Although rare in children, | + | In preschoolers, psychosis (particularly hallucinations) are most likely caused by stress or anxiety; these are transient and benign. |
| + | In school age children psychotic symptoms may be more persistent, and are more likely to be associated with drug toxicity or significant mental illness (Lewis, p. 494) | ||
| + | |||
| + | Although rare in children, early-onset schizophrenia is a frequently tested item on the PRITE and boards. | ||
==Childhood-onset Schizophrenia== | ==Childhood-onset Schizophrenia== | ||
Revision as of 18:27, 27 July 2012
Introduction
In preschoolers, psychosis (particularly hallucinations) are most likely caused by stress or anxiety; these are transient and benign. In school age children psychotic symptoms may be more persistent, and are more likely to be associated with drug toxicity or significant mental illness (Lewis, p. 494)
Although rare in children, early-onset schizophrenia is a frequently tested item on the PRITE and boards.
Childhood-onset Schizophrenia
- Schizophrenic psychoses that arise before the age of 13 have a very poor prognosis. The disease usually continues to progress in adolescence and adulthood. It can be diagnosed with the same criteria that are used for adults. (1)
- Patients whose disease is of acute onset (25%), with productive schizophrenic manifestations such as hallucinations and delusions (positive manifestations), have a better prognosis than those whose disease begins insidiously (75%) and takes an unfavorable course, with depressive states and continually worsening impairment of cognitive function.
- The patient's premorbid personality plays a major role. Patients who were described as socially active, intelligent, and integrated children and adolescents before they became ill have a better prognosis than those who were intellectually impaired, timid, introverted and uncommunicative before they became ill.
- The prognosis seems to be better for patients who have no family history of schizophrenia, those whose families cooperate well, and those whose condition improves rapidly during inpatient treatment.
- The few available studies on the course and outcome of schizophrenia beginning in childhood and early adolescence confirm that they are much worse than in adult-onset schizophrenia.
- A 42-year longitudinal study of patients with childhood-onset schizophrenia revealed their suicide rate to be higher than that of patients with adult-onset schizophrenia.
Treatment
Atypical antipsychotics are the mainstay of treatment, In the only Double-Blind RCT, clozapine showed somewhat better results vs olanzapine (particularly in improving negative symptoms), but also more side effects. In the open-label follow-up most children were switched from olanzapine to clozapine. (2)
Other Pearls
- Anxiety/stress is the most common cause of hallucinations in preschool children.
- Visual hallucinations are common in COS, and are associated with greater clinical impairment and greater compromise in overall brain functioning. (3)
- On imaging COS children show progressive loss of gray matter, delayed/disrupted white matter growth, and a progressive decline in cerebellar volume, some of which are shared by their healthy siblings
References
1. Neuropsychobiology 2012;66(1):63-9 "Early-onset schizophrenia"
2. Shaw P et.al Childhood-onset schizophrenia: A double-blind, randomized clozapine-olanzapine comparison. Arch Gen Psychiatry. 2006 Jul;63(7):721-30.
3. David Cn et. al. Childhood onset schizophrenia: high rate of visual hallucinations.J Am Acad Child Adolesc Psychiatry. 2011 Jul;50(7):681-686.e3. Epub 2011 Jun 11.