Early Onset Schizophrenia

SchizophreniaMeghan Mohon

Senior Seminar Presentation

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Topics to be DiscussedIntroductionSymptomsDiagnosisBiological features/ possible causesEffects on lifeTreatment options

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IntroductionSchizophrenia defined: Chronic mental disorder characterized primarily by disoriented thinking, breaks with reality, and other strange behaviors that impair functioningExercise: Close your eyes

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Early-Onset SchizophreniaUnder the age of 18Very early-onset (childhood-onset) in those under the age of 13Typically involves an increase in the severity of symptoms

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History of SchizophreniaAccounts in ancient societies Emile Kraepelin first classified it (as Dementia Praecox) in 1887Eugen Bleuler coined the term schizophrenia (meaning Split mind) in 1911

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StatisticsSchizophrenia: Approximately 1% of the world populationApproximately 3 million people in the U.S. Number one cause of premature death is suicide Early-onset schizophrenia: Approximately 1% of those with schizophreniaSex ratio disputeddiffers depending on various factors

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SymptomsDelusionsHallucinationsDisorganized thinkingGrossly disorganized or abnormal motor behaviorNegative symptoms

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Delusions & HallucinationsDelusions: abnormal, and often bizarre (or implausible) beliefs that cannot be changed even if the person is given conflicting evidenceMany different types/themes: persecutory, referential, grandiose, somatic, erotomanic, etc. Hallucinations: vivid experiences that occur with no external stimulusMost common: Auditory (i.e.: hearing voices or sounds)Can also manifest through any of the other senses (visual, scent, feel, taste)

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Disorganized Thinking & Abnormal Motor BehaviorDisorganized thinking: Inferred by speechcan include derailment, tangentiality, and even incoherenceMust be severe enough to cause impairment in communication skillsAbnormal Motor Behavior: Behaviors ranging from silliness to sudden bursts of excitement or agitation. Includes catatonic behavior (lack of proper motor responses, rigid posture, purposeless motor activity, resisting instruction)

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Negative SymptomsDiminished emotional expression: Includes decrease of facial expression, body language (hand or head movements), and/or eye contact Avolition: Decrease in motivation to take part in purposeful activities Others: Alogia (less speech output), anhedonia (lower ability to experience pleasure with positive stimuli), and asociality (lack of interest in social interaction)

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Video Examplehttps://www.youtube.com/watch?v=nL_OTM7I3C0

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DiagnosisDiagnostic and Statistical Manual DSM V versus previous editionsMain difference is use of categories/ types: Paranoid, catatonic, disorganized, undifferentiated, and residualSymptoms may appear abruptly (in the form of a psychotic episode) but are generally slow to manifestThe earlier the age of onset, the worse the prognosis typically is (accounting for other variables)

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DiagnosisSchizophrenia last a minimum of 6 months, with 1 month of active-phase symptoms3 phases: Prodromal, active, and residualSection A: two of the following must be present (for majority of a month-long period) 1. Delusions2. Hallucinations3. Disorganized Speech4. Grossly disorganized or catatonic behavior5. Negative symptoms

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DiagnosisOther criteria in the DSM V: Level of functioning significantly reducedOther disorders (including schizoaffective, bipolar, and depressive disorders)If diagnosed with autism spectrum disorder or a communication disordermust have prominent delusions or hallucinationsAlso high rates of comorbid conditions (depression, anxiety, attention deficit disorder, and conduct disorder)

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Challenges of DiagnosisImaginary friends, fantasy playDelusions/ Hallucinations less elaborate than adultsOften misdiagnosed as other disorders due to its raritythus multi-method assessment is important

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Possible CausesNature versus nurture debateInteraction of genetic, neurological, and environmental factorsConsidered by many to be a neurodevelopmental illnessBiological risk factors clearly exist, but onset and severity seem to be influenced by environment as wellCatastrophic pre and perinatal events pose significant environmental risk factorsOther possible factors may include trauma, stress, and substance use

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Biological FactorsBrain structure: Imagine technologies show that those with schizophrenia have enlarged cerebral ventricles and some size reduction in certain regions of the brainOther issues include gray matter loss, blood flow to the prefrontal cortex, and reduced functioning of certain areas of the brain

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Biological FactorsGenetics: inheritance is a risk factor as there is an element of genetic predispositionTwin studies and genetic risk prevalence estimatesMany genes identified as being related to schizophrenia There are other theories including the idea that excess dopamine has something to do with psychotic symptoms, but there is a lack of evidence to support those ideas

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Effects on LifeSchizophrenia (especially EOS) can significantly impact many facets of life, including Family lifeFrustration and confusion on both endsEducation Concentration issues, special attention Social interactionsIsolation, disinterest in and distancing from others Effect on functioning in one or more aspects of life is a diagnostic criteria

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TreatmentsSchizophrenia has no cureTreatment of children/ adolescents with EOS is sparsePharmacological treatments seems to have the most supportTwo main types of antipsychotic medications: First Generation Antipsychotics (FGAs) and Second Generation Antipsychotics (SGAs)

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TreatmentsNon-pharmacological options availableNo psychological treatments have enough evidence to be completely supportedTherapy and educational optionsImportance of family involvement in therapyRecovery and relapse

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DiscussionAny questions?

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ReferencesAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.Armando, M., Pontillo, M., & Vicari, S. (2015). Psychosocial interventions for very early and early-onset schizophrenia: A review of treatment efficacy.Current Opinion in Psychiatry,28(4), 312-323. doi:10.1097/YCO.0000000000000165Asarnow, J., Tompson, M., & McGrath, E. (2004). Childhood-onset schizophrenia: Clinical and treatment issues. Journal of Child Psychology and Psychiatry, 45, 180-194.Caplan, R., Guthrie, D., Gish, B., Tanguay, P., & David-Lando, G. (1989). The kiddie formal thought disorder scale: clinical assessment, reliability, and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 408-416.David, C. N., Greenstein, D., Clasen, L., Gochman, P., Miller, R., Tossell, J. W., & ... Rapoport, J. L. (2011). Childhood onset schizophrenia: High rate of visual hallucination. Journal of the American Academy of Child & Adolescent Psychiatry, 50(7), 681-686. doi:10.1016/j.jaac.2011.03.020Driver, D. I., Gogtay, N., & Rapoport, J. L. (2013). Childhood onset schizophrenia and early onset schizophrenia spectrum disorders. Child and Adolescent Psychiatric Clinics of North America, 22(4), 539-555. doi:10.1016/j.chc.2013.04.001

ReferencesEllie F. (2013, January 14). Jani Schofield schizophrenia (Video file). Retrieved from https://www.youtube.com/watch?v=nL_OTM7I3C0Frangou, S. (2013). Neurocognition in early-onset schizophrenia. Child and Adolescent Psychiatric Clinics of North America, 22(4), 715-726. doi:10.1016/j.chc.2013.04.007Krasner, A., & Winter, D. (2015). Childhood onset schizophrenia. In J. B. McCarthy, J. B. McCarthy (Eds.), Psychosis in childhood and adolescence (pp. 93-106). New York, NY, US: Routledge/Taylor & Francis Group.National Institute of Mental Health. 2007. Schizophrenia. (Online). Retrieved from: http://www.nimh.nih.gov/health/publications/schizophrenia/complete-index.shtml. (May 2010).Remschmidt, H. E., Schulz, E., Martin, M., & Warnke, A. (1994). Childhood-onset schizophrenia: History of the concept and recent studies. Schizophrenia Bulletin, 20(4), 727-745.Sarkar, S., & Grover, S. (2013). Antipsychotics in children and adolescents with schizophrenia: A systematic review and meta-analysis. Indian Journal of Pharmacology, 45(5), 439-446. doi:10.4103/0253-7613.117720

ReferencesThompson, P. M., Vidal, C., Giedd, J. N., Gochman, P., Blumenthal, J., Nicolson, R., & ... Rapoport, J. L. (2001). Mapping adolescent brain change reveals dynamic wave of accelerated gray matter loss in very early-onset schizophrenia. Proceedings of the National Academy of Sciences of the United States of America, (20). 11650.Untu, I., Moisa, S. M., Burlea, S. L., Ciubara, A., Lupu, V. V., & Anton-Paduraru, D. (2015). Very early and early onset schizophrenia spectrum disorders: Diagnostic challenge. Romanian Journal of Pediatrics, 64(1), 24-27.Ventura, J., Ered, A., Gretchen-Doorly, D., Subotnik, K. L., Horan, W. P., Hellemann, G. S., & Nuechterlein, K. H. (2015). Theory of mind in the early course of schizophrenia: Stability, symptom and neurocognitive correlates, and relationship with functioning. Psychological Medicine, 45(10), 2031-2043. doi:10.1017/S0033291714003171Wale, J. (Jarrad Wale). (2011, June 13). Auditory hallucinations-an audio representation (Video file). Retrieved from: https://www.youtube.com/watch?v=0vvU-Ajwbok

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