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March 05, 2007
Childhood-Onset Schizophrenia is Challenging to Both Diagnose and to Treat
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Childhood-onset schizophrenia (COS), like autism, is considered to be a developmental disorder involving the brain. It is characterized by onset of psychosis before the age of 13, typically preceded by co-occuring (comorbid) symptoms which overlap with those of autism spectrum disorders, affective disorders, behavior and attentional disorders, and often involves learning disabilities especially in the areas of speech and language. 99% of children with COS or childhood-onset schizoaffective disorder have comorbid diagnoses.
According to an article in the Psychiatric Times which discusses the challenges of diagnosing and treating childhood-onset schizophrenia, COS occurs in less than 1 in 10,000 children, and just 1% of patients with schizophrenia recieve the diagnosis of COS. It is 50 times more rare than adolescent-onset schizophrenia.
The current criteria in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR for the diagnosis of COS is the same as for the diagnosis in adults with the exception of wording about academics and other childhood-related tasks.
The article discusses distinguishing between delusions and simple "exaggerated magic beliefs" and between true psychotic symptoms versus symptoms of post-traumatic stress disorder (PTSD), severe anxiety, or thinking and perceptions associated with pervasive developmental disorders (PDD).
Both pharmacological (medication) and psychosocial treatments are discussed. Some psychosocial interventions that have been suggested as helpful for adults, such as family psychoeducation and cognitive behavior therapy have not been studied for children, but it is believed that they may be helpful in these cases as well. Other psychosocial therapies for children that may be needed revolve around their developmental needs, such as in the areas of social skills, vocational skills, and developing strategies for coping with symptoms.
Lastly, the prognosis (outcome) for patients with childhood-onset schizophrenia is discussed, which historically has been poor when compared with patients with either adolescent-onset or adult-onset schizophrenia. However, there are variables that are predictive of better outcomes for the child. These variables include higher intelligence before becoming ill, more positive symptoms than negative symptoms, and cooperation of the family in the treatment of the child.
The authors, Drs. Khurana, Aminzadeh, Bostic, and Pataki, point out that much research is still needed for both better psychosocial treatments as well as more effective medications for children.
Given the challenge of finding successful multimodal interventions for COS, available psychopharmacologic agents have shown some evidence of effectiveness, although all are still limited by serious adverse effects. Future investigations of combined psychosocial and pharmacologic treatments are needed to provide a broader range of effective interventions to improve long-term function of patients with COS.
Read the full article: Childhood-Onset Schizophrenia: Diagnostic and Treatment Challenges
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Posted by Jeanie Wolfson at March 5, 2007 06:50 PM
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