| disease | Childhood Schizophrenia |
Schizophrenia can occur in both adults and children, and it is a relatively common psychiatric disorder in children. This section primarily describes the clinical characteristics of childhood schizophrenia.
bubble_chart Epidemiology
The prevalence of childhood schizophrenia is lower than that in adults. According to foreign reports, the prevalence of schizophrenia in children under 15 years old is approximately 0.14% to 0.34%. Domestic literature reports that the prevalence of childhood schizophrenia is 0.05% to 0.08%, with a similar ratio between males and females. Onset before the age of 10 is relatively rare, while onset after the age of 10 significantly increases. The youngest age of onset is 3 years old, with the majority of cases occurring in adolescents aged 12 to 14.
Similar to adult schizophrenia, the exact cause of the disease remains unclear to date. It is currently believed to be possibly related to the following factors:
1. Genetic factors: The incidence of a family history of psychiatric disorders is higher among children with this condition (16-64%). Xia Zhenyi et al. (1982) suggest that the genetic mode of childhood schizophrenia is likely polygenic, with a heritability of 70%. The incidence of this condition among first-degree relatives is: parents 4.0%; siblings 6.7%. Some believe that if both parents suffer from schizophrenia, the risk of their children developing schizophrenia is about 40%; if one parent has the condition, the risk of their children developing the same disease is 7-17%, indicating that genetic factors play a significant role.
2. Organic factors: A history of perinatal damage is relatively common among children with this condition. Delayed maturation of the nervous system, soft neurological signs, and abnormal EEG findings are also more common. Recent studies have found that the P300 latency of evoked potentials in children with schizophrenia is significantly shortened and the amplitude is reduced; results from cranial CT scans, magnetic resonance imaging (MRI), and other studies suggest that damage to the frontal lobe, basal ganglia, and temporal lobe is closely related to schizophrenia.
3. Psychosocial factors: Children experiencing severe psychological trauma, such as parental divorce, death of a loved one, or failure to advance in school, are relatively common triggers for schizophrenia. Moreover, psychosocial factors also have a significant impact on the course and prognosis of the disease.4. Premorbid personality traits: Children with this condition often have introverted personalities before the illness. On the basis of personality deviation or imperfection, the influence of environmental factors increases the risk of developing the disease.
5. Biochemical factors: There is less research in this area for childhood schizophrenia. It is generally believed that this condition is related to excessive activity of the central dopaminergic system and insufficient noradrenergic function. Some studies have found increased plasma dopamine β-hydroxylase in children with this condition, while the cholinergic system is inhibited.
bubble_chart Clinical Manifestations
1. Onset Pattern: The majority of cases have a slow onset, and as age increases, acute onset gradually becomes more common.
2. Early Symptoms: The early symptoms of childhood schizophrenia mainly include changes in mood and behavior, sleep disturbances, difficulty concentrating, and learning difficulties. Some cases may exhibit obsessive thoughts and compulsive behaviors early on.
3. Basic Symptom Characteristics
(1) Clinical symptoms are closely related to age factors. Symptoms in younger children are often atypical and monotonous, while adolescent patients' symptoms gradually resemble those of adults.
(2) Emotional Disorders: Most patients exhibit social withdrawal, indifference, and estrangement from family and peers, or develop hostile emotions without reason. Symptoms such as unexplained fear, anxiety, tension, and spontaneous mood fluctuations are also common.
(3) Speech and Thought Disorders: Younger cases often show reduced speech, mutism, stereotyped repetition, unclear speech, and impoverished thought content. Older children may experience pathological fantasies, bizarre delusional content, and often have delusions of persecution, guilt, hypochondria, or non-biological lineage.(4) Perceptual Disorders: Perceptual disturbances in childhood schizophrenia are often vivid and characterized by terror and imagery. These may include visual or auditory hallucinations (verbal or non-verbal), fantastical hallucinations, and perceptual synthesis disorders (such as believing one's body has changed or become ugly), especially common in adolescent patients.
(5) Motor and Behavioral Abnormalities: Patients often exhibit restlessness, disorganized behavior, aimless running, or appear sluggish, weak, slow, and rigid with reduced movement. They may also display peculiar movements or postures, often with imitative or ritualistic stereotyped actions. A few patients may show catatonic stupor and excitement, impulsivity, aggression, and destructive behavior.
(6) Intellectual Activity Disorders: These are mainly seen in children with early-onset illness. Most cases do not show significant intellectual impairment. {|108|}
The main diagnostic criteria for childhood schizophrenia are as follows:
1. Symptom Criteria: Possessing the fundamental symptoms of schizophrenia, characterized primarily by thought association disorders and emotional disorders, with significant abnormalities and incoordination in behavioral activities corresponding to their age, and at least one of the following symptoms:
(1) Poverty of thought, loose or fragmented associations, bizarre thought content, pathological fantasies, and delusions.(2) Emotional indifference, social withdrawal, reduced interest, spontaneous mood swings, unexplained crying or laughing, or anxiety and fear.
(3) In a state of clear consciousness, experiencing perceptual disturbances, behavioral disorganization, psychomotor excitement, mannerisms, negativism, or sluggishness and reduced activity.
2. Severity Criteria: Significant impairment in adaptive abilities, markedly abnormal compared to most normal children of the same age, including changes and deficits in interpersonal relationships, academic performance, labor, and self-help abilities in various settings such as home and school.
3. Time Criteria: The course of the illness must last for at least one month.
4. Exclusion: Organic mental disorders, mental disorders due to physical diseases, affective mental disorders, and developmental disorders.
Childhood schizophrenia often has an insidious onset and progresses slowly, with atypical symptoms, making diagnosis particularly challenging, especially in younger patients. Therefore, thorough examination and in-depth observation are necessary. It must also be differentiated from childhood autism, mental retardation, hyperactivity disorder, conduct disorder, and organic mental disorders to avoid misdiagnosis or fistula disease diagnosis.
bubble_chart Treatment Measures
The treatment of this condition is fundamentally similar to that for adults, primarily involving a combination of antipsychotic medication, psychotherapy, and educational training. The choice of various treatments is based not only on the main clinical symptoms but also on the individual's specific circumstances, such as age, physical development, and nutritional status, which are comprehensively considered. Commonly used antipsychotic drugs include chlorpromazine, haloperidol, perphenazine, sulpiride, and clozapine, with an efficacy rate of 50-60%.
Follow-up observations indicate that a younger age of onset, a slow onset with a gradual course, progressive development, and intellectual decline are associated with a poorer prognosis. Therefore, early diagnosis and timely, active treatment are crucial for the prognosis of childhood schizophrenia.