The Realities of Childhood Schizophrenia
Community Psychiatry’s Regional Medical Director Abhijit Ramanujam, M.D. was featured in the Psychiatric Times Podcast, PsychPearls discussing clinically relevant issues in childhood schizophrenia. Click on one of the links below to listen to the entire conversation.
Psychiatric Times: https://www.psychiatrictimes.com/view/realities-childhood-schizophrenia
Laurie Martin (LEM): How common is schizophrenia in children under the age of 18?
Abhijit Ramanujam, MD: The worldwide prevalence of early-onset schizophrenia, that is symptoms prior to the age of 18yrs is estimated to be about 0.5% of the population, whereas childhood-onset or very early-onset schizophrenia which begins prior to the age of 13, has been estimated to be around 0.04% in the United States. Much less is known about the prevalence of childhood-onset schizophrenia internationally.
LEM: Is there an age in which a child is too young to consider a diagnosis of schizophrenia? What do we know about early detection of schizophrenia and how soon can it be diagnosed?
Abhijit Ramanujam, MD: Although there is no official age considered too young for a diagnosis of schizophrenia, we have to keep in mind that childhood-onset schizophrenia that starts before aged 13 years is extremely rare.
Whenever a child is suspected of having schizophrenia, the clinical assessment should include a thorough personal, medication, psychosocial and family history as well as physical examination, neurological workup, laboratory evaluation, and collateral information from family and schools.
In terms of diagnosis, DSM-5 diagnostic criteria for schizophrenia in childhood and adolescence are the same as those used for adult disorders. They include the presence of significant positive and negative symptoms during a 1-month period (such as delusions or hallucinations, disorganized speech, catatonic behavior, and negative symptoms such as lack of motivation and lack of socialization). Disturbance of functioning in 1 or more major areas and continued signs of disturbance for at least 6 months, as well as the exclusion of other psychiatric or medical diagnoses.
Although the diagnostic criteria used in children are the same as those for adults, there are some key differences in clinical presentation:
• Usually hallucinations are much more common than delusions in youth with schizophrenia as compared to adults. The most common hallucinations are auditory with comments or commands. These are often accompanied by visual and tactile hallucinations.
• Although hallucinations are more common, they are least likely to reported. Many youths may not disclose auditory hallucinations since they are scared that the voices may harm them. There may also be delusions associated with it such as “The voices tell me that they will kill me if I talk about them to anyone.”
• Children and adolescents are more likely to exhibit negative symptoms such as being socially aloof or having a flat affect which can sometimes be mistaken for depression or lack of motivation for plain laziness as I have actually heard some of the parents describe it.
• Cognitive decline, in particular verbal memory, attention, and concentration, is significantly affected. Delay in language, motor, and social development, and delay or deviation in developmental milestones may be pronounced as well in childhood-onset schizophrenia; although these delays are not diagnostic, they are commonly observed.
*Please click on one of the above links to listen to the entire conversation.*