2. childhood-onset schizophrenia
A type of mental disorder that is characterized by
degeneration of thinking, motor, and emotional
processes in children and young adults under the
age of 18.
Schizophrenia is rare in children under the ages of
7–8 years old (Nordqvist & Christian 17 June 2010).
3. By the 1960s, "childhood schizophrenia"
became known as dementia infantilis.
Only about 4% of total cases of
schizophrenia occur in children under
fifteen and only 0.1–1% occur in children
under the age of ten.
Diagnosis is usually based on behavior
observed by caretakers (Wicks-Nelson et al.,
2009).
4. The DSM IV criteria used to diagnose schizophrenia in
adults can be used to diagnose schizophrenia in children.
If there is a history of autism spectrum disorder or other
communication disorder of childhood onset, the additional
diagnosis of schizophrenia is made only if prominent
delusions or hallucinations are also present for at least 1
month DSM V } (Tandon A et al., march 2013 ).
5. The prodromal phase, which precedes
psychotic symptoms, is characterized by:
• deterioration in school performance, social
withdrawal.
• disorganized behavior.
• deterioration in self-care skills.
• changes in affect.
• lack of impulse control ,hostility and
aggression, and lethargy.
6. Most research has concluded that auditory hallucinations
are the most common positive symptom in children. but
these are often difficult to differentiate from just normal
imagination or child play.
A child’s auditory hallucinations may include voices that are
conversing with each other or speaking directly to the
children themselves
(Masi G etal ., 2006).
7. Many children believe that if they do not listen to the voices, they
will harm them or someone else, e.g stares are scary things—
snakes, spiders, shadows—that aren't really there.
Some children engage in activities such as flapping the arms or
rocking, and may appear anxious or confused.
8. Delusions in childhood exceed
exaggerated magic beliefs, are often
frightening and makes child to take an
irrational action .
9. The cognitive abilities of children with schizophrenia
are lag in language, motor development and
showing borderline or mental retardation.
Such problems tend to be associated with more
brain abnormalities. (MRI) scans revealed fluid filled
cavities in the brain suggesting a shrinkage in
brain tissue volume.These children lost four times
of gray matter and neurons in their frontal lobes.
(Thompson P et al ., 2006)
10. Schizophrenia and autism
The diagnosis of schizophrenia was often given to
children who would be diagnosed as having of autism
or pervasive developmental disorder.
until DSM-II included children with autism under the
diagnostic umbrella of schizophrenia, childhood type.
study results suggest that there are both clinical
and biological links between autism and
schizophrenia. The question regarding whether there
is phenotypic overlap or co-morbidity .
11. Unique features included lower gray matter volume
in the amygdala, caudate, and frontal and medial
gyrus for schizophrenia, and lower gray matter
volume in the putamen for autism.
schizophrenia is differentiated from autism by the
persistence of hallucinations and delusions for at
least 6 months.
It‘s age of onset—7 years or older. Autism is usually
diagnosed by age 3 (Yael Dvir MD et al ., 2011).
12. Shared clinical features
Social withdrawal, communication impairment, and
poor eye to eye contact .
When higher intelligence autistics are stressed, they
become highly anxious and may appear thought-
disordered.
children with COS are noted with language delays
and transient motor stereotypes.
13. Schizophrenia is also must
differentiated from a type of brief
psychosis and dissociative disorders in
children.
14. Mangment of COS
successful multimodal interventions:
• Psychopharmacologic: For example, Rispiridone,
aripipazole, quetiapine and Olanzapine.
• Psychosocial interventions: for social and family
relationship. Also social skills training for
enhancing communication and vocational skills.
• Psychoeducation: helps the patient and his family to
understand the illness, treatment options, prognosis
and reduce relapse .
15. OUTCOME OF COS
In general, the earlier the onset of COS, the
poorer the prognosis.
Better prognoses of COS are higher
among premorbid higher intelligence, more
positive than negative symptoms of
schizophrenia and cooperation of family in
treatment.
