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Childhood Schizophrenia

By Josephine Elia, MD, Pediatrics, Division of Behavioral Health

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(See also Schizophrenia.)

Schizophrenia is the presence of hallucinations and delusions causing considerable psychosocial dysfunction and lasting 6 mo.

Onset of schizophrenia is typically from mid-adolescence to the mid-30s, with a peak age of onset in the 20s. Features in adolescents and young adults are similar. Schizophrenia in prepubertal children (childhood-onset schizophrenia [COS]), in which symptoms similar to those of the adolescent/young adult-onset form develop before age 12, is extremely rare.

Although the first episode usually occurs in young adults, some contributory neurodevelopmental events and experiences occur earlier (eg, during the perinatal period).

These perinatal risk factors include the following:

  • Genetic disorders (particularly those that increase risk of childhood onset)

  • Exposure to certain drugs or substances (eg, cannabis) during a vulnerable period

  • Prenatal undernutrition

  • Labor complications, hypoxia, perinatal infection, placental abruption or insufficiency

  • Childhood brain injury

Other risk factors, which occur later (eg, drug use later in adolescence), may then trigger the onset of schizophrenia.

Manifestations of COS are usually similar to those in adolescents and adults, but delusions and visual hallucinations (which may be more common among children) may be less elaborate. Additional characteristics also help distinguish COS from the adolescent/young adult form:

  • More severe symptoms

  • A strong family history

  • Increased prevalence of genetic abnormalities, developmental abnormalities (eg, pervasive developmental disorder, intellectual disability), and motor abnormalities

  • Increased prevalence of premorbid social difficulties

  • Insidious onset

  • Cognitive deterioration

  • Neuroanatomical changes (progressive loss of cortical gray matter volume, increase in ventricular volume)

Sudden-onset psychosis in young children should always be treated as a medical emergency with a thorough medical assessment to search for a physiologic cause of the mental status change; these causes include

  • Drugs (in younger children, stimulants and corticosteroids; in adolescents, drugs of abuse)

  • CNS infection or injury

  • Thyroid disorders

  • NMDA receptor antibodies

  • SLE

  • Porphyria

  • Wilson disease

Treatment is complex, with variable outcomes, and referral to a child and adolescent psychiatrist is strongly recommended.

* This is the Professional Version. *