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Chapter: Paediatrics: Child and family psychiatry

Paediatrics: Schizophrenia

Schizophrenia is characterized by disorders of thought, perception, mood, and sometimes posture.



Schizophrenia is characterized by disorders of thought, perception, mood, and sometimes posture. Peak onset is in young adult life. Prevalence in mid teens is 70.25% with equal numbers of males and females. Schizophrenia is very uncommon in the pre-pubertal child, when it does occur in this age group it is more common in boys.




There is a significant genetic contribution with heritability estimates as high as 82 and first-degree relatives having a 12-fold increase in risk of developing the illness. Several pre- and perinatal factors also appear to be important. These include maternal infections, stressful events during pregnancy and obstetric complications.


Clinical features


The features of schizophrenia are complex. Refer to a standard adult psy-chiatric text for a more complete description of terms and their meaning. Onset may be insidious or acute. Core features of schizophrenia include the following:


·  Thought disorder: thoughts inserted or removed from one’s head or broadcast to others or disorganized with abnormal speech patterns.

·  Auditory hallucinations: external voices discussing the patient or commenting on his/her behaviour.


·  Delusions: fixed beliefs that are false not open to reason, and not in keeping with the patient’s developmental or cultural context.

·  Disorders of posture: holding abnormal postures.


Differential diagnosis


Important differential diagnoses include affective psychosis (bipolar dis-order/psychotic depression), drug-induced psychoses, and psychoses sec-ondary to other organic conditions, temporal lobe epilepsy, autism spectrum disorder.




As a schizophrenia-type psychosis can be caused by organic conditions, it is essential that signs of these be sought. Include full neurological exami-nation, and check for thyroid, adrenal, or pituitary dysfunction, and drug screen.




Schizophrenia is often complex and difficult to treat. Children and adoles-cents will require both:

·  Specific therapies, aimed at reducing the core symptoms.


·  General therapies, relating to the psychological, social, and educational needs of the child/young person and their family.


The aim is usually to deliver treatment on an out-patient basis, but it may occasionally be necessary to consider day or in-patient treatment.

Traditional psychotherapies have little effect, but learning based thera-pies and those that increase family support and reduce intrusive and criti-cal interactions can improve functioning and decrease relapse rates.


Antipsychotic medication, most commonly the newer atypical antipsy-chotics with preferable side-effect profiles, is often effective. Relapses are fewer when families are supportive, but not intrusive or critical.


The acute phase can progress to a chronic state with poor motiva-tion and inactivity. Clozapine (an atypical antipsychotic drug) may amel-iorate this, but can cause agranulocytosis so ongoing blood monitoring is essential.




Prognosis is relatively good for a single acute episode in a previously well functioning teenager. However, it is worse for insidiously developing ill-ness particularly in a child with pre-existing developmental difficulties. The differentiation between schizophrenia and affective psychosis may be par-ticularly difficult and it is not uncommon for patients’ diagnoses to switch between the two.


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