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Schizophrenia in children is defined in the same way as for adolescents
and adults, based on characteristic psychotic symptoms (ie, hallucinations,
delusions, and symptoms of thought disorder) accompanied by deficits
in adaptive functioning for at least 6 months.1 Historically,
the term was used broadly and included children who had what we
now know to be autism; schizophrenia and autism are now seen as
being quite different.2 The concept of childhood
psychosis is problematic, considering the marked developmental changes
in children’s understanding of reality (see Table
95-1).
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Although adolescent- and adult-onset schizophrenia is relatively
common, childhood onset of the disorder is rare (2 in 10,000). As
with adults, there may be a preponderance of lower socioeconomic
status in affected children. Also as with adults, there are frequent
associations with anxiety and mood disorders.3
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Various lines of evidence suggest the importance of neurobiological
factors in the pathogenesis of this syndrome. Neuropsychological studies
reveal deficits in attention, short-term memory, and information
processing. Abnormalities in smooth-pursuit eye movements (saccades)
are frequent. Family studies (eg, of adopted children) suggest that
rates of schizophrenia are substantially higher among children whose
parents have the disorder.1 It had been proposed
that psychological factors are important in the pathogenesis, but
data supporting this notion are limited. However, stressful life
experiences may be important in precipitating psychotic episodes
in children. Exposure to pharmacological agents (eg, stimulants)
may produce a schizophrenic-like psychosis. Changes in MRI studies
include increased volume of the lateral ventricle and basal ganglia
and decreased gray matter; it is possible that some of these changes
may reflect long-term medication effects.4 Recent genetic
studies have identified several microdeletions and copy number variations
that appear to increase the risk for schizophrenia in adults.
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Children who develop schizophrenia often demonstrate premorbid
features such as problems with language development, attention, inhibition,
withdrawal, and social oddity.3 Although studies
of adults who develop schizophrenia suggest some childhood precursors
of the condition, their applicability to childhood schizophrenia
is limited.
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This condition rarely manifests before 5 years of age. Three
patterns of onset are noted: acute, insidious with gradual deterioration,
and insidious onset with an acute exacerbation of disturbance. Males
are ...