Schizophrenia is a disorder characterized by distorted perceptions of reality, including hallucinations, delusions and "disorganized" thinking and speech. Our guide explains the signs and symptoms of schizophrenia and how it's diagnosed and treated, usually in young adults.
Schizophrenia: What Is It?
Schizophrenia is a chronic psychiatric disorder characterized by distorted thinking, hallucinations, and/or delusions—called “positive” symptoms—and “negative” symptoms including social isolation and flat affect. Children with schizophrenia often experience paranoid delusions—seeing hostile intent where there isn’t any—and their resulting behavior is misinterpreted as conduct disorder. They may believe other people can control their thoughts or read their minds, or believe that there are special messages for them in things like television shows or coincidences. While childhood schizophrenia is very uncommon, preliminary symptoms of the disorder can manifest in younger kids.
Schizophrenia: What to Look For
Children with schizophrenia may exhibit unusual thoughts and behavior. If your child has schizophrenia, he might express ideas that don’t make sense, appear internally distracted, or perceive hostility in others where none is apparent. While it is common for young children to have imaginary friends, the voices that kids with schizophrenia hear are experienced as external, not internal, as if they’re hearing someone else talking, or telling them what to do. Other signs include a child’s belief that strangers know about him or are talking about him, or that the television is relaying special messages to him. For a child with schizophrenia, everyday tasks such as eating, bathing, attending school, and communicating coherently may become difficult, and he might withdraw from social interaction or appear to have little emotional range.
Schizophrenia: Risk Factors
Children who have a family history of schizophrenia are at higher risk for the disorder, though most kids who have a parent with schizophrenia never develop it. Pregnancy and birth complications are also linked to schizophrenia, though, again, the vast majority of children with these risk factors don’t develop the disorder.
The characteristic symptoms of schizophrenia include delusions, or beliefs held contrary to all evidence; hallucinations, or distortions in the perception of reality; disorganized or incoherent speech; and extremely disorganized or catatonic behavior (i.e. physical immobility or excessive mobility). Children with schizophrenia may display a lack of emotional responsiveness (called blunted or flattened affect), a lack of motivation (called avolition) and a lack of voluntary speech (called alogia). Other symptoms may include strange eating rituals, irritability, or inappropriate emotions. A child will be diagnosed with schizophrenia only if his symptoms interfere with age-appropriate activities, and have been in evidence for at least 6 months.
Schizophrenia is very difficult to diagnose because other psychiatric disorders (bipolar disorder, OCD, depression, even substance abuse) can generate similar symptoms if they manifest in psychosis. It is possible children with schizophrenia will be falsely diagnosed with conduct disorder because paranoia makes them respond in hostile or oppositional ways.
The recommended treatment for schizophrenia, called Coordinated Specialty Care, involves a combination of services coordinated by a group of professionals working with the patient and the family. This treatment, within the first two to three years after a patient’s initial psychotic episode, has been shown to decrease relapses of psychosis by more than 50 percent and prevent much of the disability associated with a psychotic illness.
Elements of the treatment include:
- Low doses of antipsychotic medication
- Cognitive behavioral therapy for psychosis (CBTp)
- Family education and support
- Educational and vocational rehabilitation
Unlike the old standard treatment for schizophrenia, which involved higher doses of medication and no follow-up after hospitalization, the goal of early treatment is not only to reduce psychotic symptoms, but also to help young people learn to manage them and to construct a support network to prevent relapse.
Schizophrenia: Risk For Other Disorders
Some children diagnosed with schizophrenia in fact have other disorders that manifest in psychosis, including obsessive-compulsive disorder and depression. And some develop other disorders as well, including OCD, panic disorder and post-traumatic stress disorder. Substance abuse is also a big problem for adolescents and young adults with schizophrenia, as it may drastically worsen their symptoms.