Mental health articles

Adolescent schizophrenia

Children with schizophrenia often present with earlier developmental delays and poor premorbid functioning. Developmental delays are particularly common in the areas of language development, reading and bladder control. A third of children also show difficulties in forming socioemotional relationships. The onset of schizophrenia is usually insidious. The recognition of symptoms during the early phase may be common to other childhood psychiatric disorders before merging with the prodromal symptoms preceding the onset of psychotic symptoms. There is usually a strong family history of psychosis/schizophrenia.

The main features of the clinical picture are delusional beliefs, thought disorder, hallucinations and disorders of affect. Delusions in schizophrenia include paranoid delusions and beliefs that thoughts are being withdrawn or broadcast from one’s head or externally controlled. Associations between thoughts may be loosened and move between topics in an unrelated way. In extreme cases the patient may be incoherent. Hallucinations are most often auditory and may consist of voices discussing the patient or repeating their thoughts out loud. Emotionally, the patient often presents as flattened, inappropriate or blunted. Adolescent schizophrenia is generally characterized by prominent negative features (inappropriate affect and avolition) rather than prominent delusions or hallucinations when compared with adult schizophrenia. Before starting treatment it is important to seek consent from the patient and adults holding parental responsibility. Assessment of competence to give consent needs to be tailored to the young person’s age and understanding of the purpose, nature and likely effects and risks. Inpatient admission should be considered where there is serious risk to the safety of the young person or others. Lack of insight and poor compliance with treatment are other factors which need to be considered. Alternatively, the patient may be treated as a day patient or an outpatient.

Many of the antipsychotic drugs used in adults are not licensed for younger patients. The newer atypical antipsychotic drugs are increasingly the first line treatment of choice. Olanzapine and risperidone have been used with good effect. During the acute phase, benzodiazepine may be used to relieve distress or reduce behavioural disturbances. Psychoeducation of parents and the patient about the illness, treatment and prognosis, helps their understanding of an illness which can be frightening and stigmatizing. Cognitive behavioural strategies and supportive counselling may be beneficial.

Tags: adolescent, schizophrenia, symptoms